HomeMy WebLinkAboutUtility Company ApprovalLUr 12F.
WATER
COMM
3L
SEWER
RES
g METER SZ.
M/F
IRR
$
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
Ojo
CFCAVATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ agg• �� TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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ACCT. # L 6�5-11Q —`"
SERVICE ADDRESS
til
i0 30957
SUBDIVISION .11ZtlI�� LO7 CO BLOCK
BILLING ADDRESS��
EMAIL ADDRESS:
PHONE # 90 - 5�9 MOVE IN/CLOSING DATE
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This application hereby requests and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates, rules and
regulations, which by reference are made a part of this contract. Applicant agrees to pay Utility promptly for
such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
FTAPPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLIED FOR .ON THE DAY THE WATER METER OR OTHER UTnXrY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING TBE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY