HomeMy WebLinkAboututilityWATER
COMM
iL SEWER RES
METER SZ. M/F
IRR
$ A0 00 SECURITY DEP
SERVICE FEE
SAME SAME DAY FEE
OVERTIME FEE
430. Qa METER INSTAL
3173. Q(J C€C/WATER
FPUA CFC
CFC/SEWER
D� GUAR. REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
02 G/WERM111
SERVICE ADDRESS ?2 i1Z;2Y1 U _.
SUBDIVISION_ _ _ i2�- LOT BtDCK�
BILLING
ADDRESSQ� 6W
EMAIL ADDRESS: p /
PRONE # q05+ a i 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 V4LL BEGIN PAYING BASE FACix iClEY CHARGES FOR TEE UTHXI'Y SERVICE
APP= FOR ON THE DAY THE WATER METER OR OTHER UIU"Y SERVICE CONNFkMON IS DWAIJM AT
APPLICANCS PROPERTY, REGARDLESS OF VMN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
DATE RECEIVED
SEC/FED ID
SPOUSE SOCIAL
OFFICE USE ONLY �S CASH CHECK #_. Z _ r
�V 4)-b»
RECEIVED BY