HomeMy WebLinkAboututilityWATER
iL SEWER
METER SZ.
COMI41
�- RES
M/F
IRR
$ 0& SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
99�1 40 METER INSTAL
31 %3_ 00 CFC/WATER
FPUA CFC
.� CFC/SEWER
D$ GUAR. REV.
aa}} LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. # /S6-Z/V? "-r
SERVICEADDRESS 5CQ6 0 ¢i�)(iii�LY1 d SS r
SUBDIVISION 14k/!%e—.. LOT Is BLOCK „
BILLING
EMAILADDRE/S�S: p �n
PHONE # �V 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 UFHM SERVICE
APPLIED FOR ON TIIB DAY THE WATER METER OR OTHER U 1111TY SERVICE CONNECTION IS INSTALLED AT
APPLICANT`S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
SIGNATURE
NAME OF SPOUSE
SOCIAL SECIFED ID
SPOUSE SOCIAL
OFFICE USE ONLY �7 Lttk�
6C
DATE RECEIVED " CASH CHECK#�iP� 1 RECEIVED BY