HomeMy WebLinkAboutNew Customer Application ( Water, Sewer )`Y, LL,c. L ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
MAO-
NEW CUSTOMER APPLICATION
WATER 90MM
SEWER RES
METER SZ. M/F
IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
4 614 METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
" $ TOTAL
NAME Z0450-22, " n
ACCT. # ! U� — ! -7 LID
SERVICE ADDRESS Il`o1.kw•G (1 a
3g6a - &Q 7 - da 3 9 Oao - O
SUBDIVISION ' `,` '`' n er ✓lr �-✓4'45 LOT Rol /5 BLOCK
BILLING ADDRESS
EMAIL
wr vv� GV ' OZP
PHONE #'7_2a ! S R5 MOVE IN/CLOSING DATE (y 02
- 1
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.
., LAPPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE IJMXrY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTHXrY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUS
TJMER SIGNATURE SOCIAL SEC/FED ID / ?
GC/ G
NAME OF SPOUSE �6 (' c ��� • i7 +� SPOUSE SOCIAL
I
OFFICE USE ONLY
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DATE RECEIVED I1- % (" Q CASH V (�71C RECEIVED BY Z