HomeMy WebLinkAboutWater & Sewer ApplicationWATER
SEWER
METER SZ.
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RES
M/F
IRR
$ - SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ �� TOTAL
�' NAME
ST LUCI:Ej000NTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
SERVICEADDRESS ')(F)LJso VIE —
�L
SUBDIVISION I LOT BLOCK
BILLING ADDRESS (0 ()- i ' 1 / �I1r/nol F1 '-Dr y(_
f EMAIL ADDRESS: bf-,i'/) E1 _� (-- d co/t',
,A -PHONE ## -)-7 G - S1 !4 51/ q 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 UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPIWY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID _
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED I ��~� CASH CHECK# RECEIVED BY�
-�' \11