HomeMy WebLinkAboutHealth Dept Septic Approvalr/ WATER
COMM
SEWER
RES
METER SZ.
M/F
IRR
$
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
�Ti QQ
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 600
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. # /�✓ 7"p� cc/OS T
SERVICE ADD
ill
BILLING
U
LOT & 3 BLOCK_
EMAIL ADDRESS: Q L/
PHONE #YO5 a T 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 UTILi7t'Y SERVICE
FX APPLIED FOR ON THE DAY THE WATER METER. ' OR OTHER U1111M SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
DATE RECEIVEDf r
SOCIAL SEC/FED ID
SPOUSE SOCIAL