HomeMy WebLinkAboutUtility Company ApprovalEr C-ILF.-
1/ WATER COMM
SEWER RES
METER SZ. M/F
IRR
$ e563 O
SECURITY DEP .
SERVICE FEE
SAME DAY FEE
OVERTIME.FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ �paPj TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAM
ACCT. # ` 6-5-TOQ — 3367
SERVICE ADDRESS
4_'
SUBD
BILLING
LOT Yr BLOCK_____
EMAIL ADDRESS: �]
PHONE #'7 05 �cJ�/ MOVE IN/CLOSING DATE
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.
aAPPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING SASE FACILITY CHARGES FOR THE UTRXIY SERVICE
APPLIED FOR ON TEE DAY THE WATER METER OR OTHER UTILITY 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