HomeMy WebLinkAboutUtility ApprovalWATER
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St. Lucie County - PUTIL
ST LUCI,E1.1-17-2021.-01:11:22
COUNTY WATER & SEWER D 6062 7739
NEW CUSTOMER APPLICATION ELLIS6IC� OL A.
FORTFL
34951
Amount Tendered: 8,140.00
NAME .C��� �€� t-LL Amount Paid: 8,140.00
ACCT. # �D 7 j Change Due: 0.00
Thank You
SERVICE ADDRESS �t Ci f�`t-- l� User ID: MURRAYA
1 r rr
SUBDIVISION LOT c?`1 BLOCK
BILLING ADDRESS�0nol
EMAIL ADDRESS: i (,q) &- 6 t1(1i'� NOT
PHONE lw'jr, 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 servicesjfi a�gofOiance with the established rules and regulations.
CUSTOMERS DOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTIUTY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTIIdTY 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 0/ 7 74 Y b -Z-> 3I
NAME OF SPOUSE �� l9�vj�r SPOUSE SOCIAL I _ I :2)
i OFFICE USE ONLY 1
DATE RECEIVED I I 1 I c,L. CASH CHECK # f RECEIVED BY