HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESWATER
SEWER
5g METER SZ.
.... ...... .......................................................................................................................................................................
^.il. L. �' LL —� ST LUCIE COUNTY WATER Sc SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
COMM
-- R ES
M/F
IRR
$ DD S9 SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
• 06 METERINSTAL
31 7,5_ UD CFC/WATER
FPUA CFC
CFC/SEWER
04 Z,.2 GUAR. REV.
LATERAL
$ i7q Q TOTAL
NAME Au/2r /�wg-f o2A41,11,&T - R,
ACCT. # 16 � 5 Vev?,
SERVICE ADDRESS 0✓0W
l -2
SUBDIVISION LOT 0 Q � i BLOCK
BILLING ADDRESS
EMAIL ADDRESS: 2n
PHONE # _� S�9 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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UIH= SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OT13ER UTH11Y SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSEC/FED ID
NAME OF SPOUSE SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY