HomeMy WebLinkAboutUtility Company Approval ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) a I I Z�tff-_5 .
D �� NEW=CU'S'TOMER APPLICATION
-, TO
X` WATER .,.. -GOMM
i �' / Y
SEWER }� :, R€S NAME /��`�, !' (/C C.I I I 'I Z U
METER SZ. x M/Fl
IRR
$ �L��/u'G� SECUR��iJi b)& SERVICE ADDRESS
SERVICE FEE Po lC -i
SAME DAY'FEE �SUBiDIV SIGN ' J U t! LOT ,,BLOCK
OVERTIME FEE
L/ v< C� } METER INSTAL BILLING ADDRESS
J , U U CFC/WATER EMAIL ADDRESS:
PHONE#`. 1 / J J > `"' MOVE IN/CLOSING DATE
CFC/SEWER
...,.-GUAR. REV. This application hereby requests and authorizes the Utility to render water and/or sewage disposal
=`h 1 services to the premises described above-Waccordance with the Utilities present or future rates,rules and'.
LATERAL--`. regulations,which by reference are made a part of this contract.Applicant agrees to pay Utility promptly for
$ T ,` } ° TOTAL 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 UIRM SERVICE.
APPLIED FOR:'-ON TI3E`,DAY. THE WATER. METER OR OTHER.UTILITY SERVICE CONNECTION IS INSTALLED AT
• APPLICANT'S;PROPERTY;REjGARDLESS OF WHEN APPLICANT STARTS UTILIZING TIREM ETER AND/OR SERVICE.
CUSTOMER SIGNATURE ' SOCIAL SEC/FED ID
NAME OESPOUSE . �l`µ'Y�`'C�s " (�' I SPOUSE SOCIAL
OFFICE USE ONLY ,t
DATE RECEIVED CASH CHECK# f RECEIVED BY