HomeMy WebLinkAboututilityWATER
JL- SEINER
METER SZ
tl. 4a L1:.:.�.711L'
COMM
RES
M/F
IRR
$ D9 Od SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
QQ METER INSTAL
317,5. oo CFC/WATER
FPUA CFC
CFC/SEWER
�F GUAR. REV.
LATERAL
$ TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
;0 - 1. -
AM. # 1S45-1/a
SERVICE ADDRESS ,51Qd-�, IY)an &0, doei 6 ' .
SUBDIVISION LOT BLOCK
BILLING ADDRESS ` WO 64q 46qtfM 10&14 C%[1��1{�L'26 lr!
EMAIL ADDRESS- nn
PHONE # ZY? 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 FACIIM CHARGES FOR THE UPIIM SERVICE
APPLM FOR ON THE DAY THE WATER METER OR OTHER U IMY SERVICE CONNECTION IS INSTALLED AT
1....' —� APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZIlMG THE NJETIKR AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
OFFICE U5E ONLY
DATE RECEIVED ' CASH CHECK# RECEIVED BY#f '
R 90Id