HomeMy WebLinkAboutUtility Company ApprovalWATER,
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SEWER
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SECUAITY'DEP
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'OVERTIME FEE
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LATERAL
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ST LUCIE COUNTY WATER &SEWER DISTRICT (SKIJ)
NEW CUSTOMER APPLICATION
6
:
SUBPIVISIQN.&- - LOT . 11,111 _- __ . BLOCK
BILLING-ADDRES
EMAILADDOSS:
PHONEW M6VE.lN,/CLOS,lN,GJ)ATE
Tfils,opplication hereby req authorizes pests -'and auihorize the Utilit.yt;)-Tortder--,water.and/or-sewago disposal
servlcds tblhe premises descr-lbed,abovo In,accordanict, With the Utilities- -resent orNture rates, -rules, -and
:p
regulatlops,wh(ch byreferenpe are made -,a ppit-.ofthis,cont.raO'.Applica.ntagrees-toipayUtility promptlyfor
such services In accordance. With -the. established rules and regulations,
CUST I OMER . SDEPOSITS-ARE ICON-NE(,30TIAgLE,.OR!,RAN5FtR.ABL5.
APPLICANT :AGREES THAT APPLICANT VALL bEGIN PAYING 'BASE .FAC, -CHARGES FOR TM.VMLTIY- SERVICE
METER, OR TIND AT
APPLIED FOR, ON_,T_M DAY 1119, W-"M. QUER, MR-M., SERVICE -CONNECHON. IS INSTA_
J, PERTYREGARDLESS. : OF� WHEN APPLICANT STARTS -UTHJMG_l='NMTER AND/OR SERVICE.,
APPLICANr&PR
0
CLISTOMERSIGNATURE 'SOCIALSECOMI.D., 7
NAME OF SPOUSE SPOUSESOCIAL
OFFICE'USEDNILY
DATERECEiVED CASH CHECK RECEIVED BY
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