HomeMy WebLinkAboututilityWATER
iL SEWER
METER SZ.
ILI
COMM
RES
M/F
rRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
;00, QQ METER INSTAL
31711 00 CFC/WATER,
FPUA CFC
3 .OQ CFC/SEWER
GUAR. REV.
LATERAL
$1 TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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ACCT. # 1S5IIQ -
SERVICE ADDRESS p5 d'7 / I Il �(!1/! r
SUBDIVISION Ke--. LOT 7 BLOCK
BILLING ADDRESS --WD 6�� �i��r rl %
EMAILADDRESS:
PHONE # -:23,17 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 VPICITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTHM Y SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE _y��ls�r L_ ____ SOCIAL SEC/FED rD
NAME OF SPOUSE SPOUSE SOCIAL
OFFICE USE — ONLY�J r !_ �f
DATE RECEIVED : - , , , _ CASH CHECK # � 4 ll&Q I RECEIVED BY
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