HomeMy WebLinkAboutWater & Sewer ApplicationWATER
SEWER
METER SZ.
COMM
RES
M/F
W
I
$ I� 00 Or)IRR
SECURITY DEP
/ SERVICE FEE
SAME DAY FEE
OVERTIME FEE
�6 9, O () METER INSTAL
3773, 0 o CFC/WATER
FPUA CFC
O d CFC/SEWER
9,'=3, a�
:GUAR.. REV.
¢ �C6&t LATERAL
$ TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT
NEW CUSTOMER APPLICATION
NAME
JUL 09 in,s
ST. Lucie co
Permitting
ACCT.# / "l� 9 9 --
SERVICE ADDRESS
/7r,>Z!�r Pu'j c--4 �4'9
SUBDIVISION Ce-801-) [✓/eV 2�tJe.S' LOT BLOCK
BILLING ADDRESS < l 01l 219M A XI-e, 46-,
EMAIL ADDRESS:TY/,Wyrd 0-&L e-bill
PHONE# `�`�� ` % �D MOVE IN/CLOSING DATE
6,59 a57S-,? movatx,7t-
Thiss 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 orfuture 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 UTILITY SERVICE
APPLIED FOR ON THE 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.
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY