HomeMy WebLinkAboutUtility Company Approval1/ WATER
SEWER
METER SZ.
COMM
RES
M/F
iRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 600 - TOTAL
�z_
NAM
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. # 165VO? — , 3305
SERVICE ADDRESS
11A
At
BILLING
�'
LOT 4 � BLOCK _
EMAIL ADDRESS:
PHONE#qQ�'�! P5 ^ o c_:2/), / MOVE IN/CLOSING DATE
3a�
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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING SASE FACILITY CHARGES FOR THE UTHITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTIIIITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY