HomeMy WebLinkAboutNew Customer Application Water & SewerST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
ti � rn NEW CUSTOMER APPLICATION
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SEINER 7R E S
S METER SZ. M/F
IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIMETEE
METER INSTAL
CFC/WATER
FPUA CFC
-CFC/SEWER
GUAR. REV.
LATERAL
$ 9YJ d jO TOTAL
SERVICE ADDRESS 1
Fort Pierce, FL 34945.
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EMAIL ADDRESS: 1D M PAR RI N 00—D R H ORTO N. C O M
PHONE#4�3Q 1J �c�cJ` / l c;Z MOVE IN/CLOSING DATE
BLOCK
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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, whleh by reference are made -a part of this contract: Applica nt agrees to pay Utility promptly for
such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
aAPPLICANT AGREES THAT APPLICANT 'WIM BEGAN PAIING BASE FAC = CHARGES FOR THE UT111TY SERVICE
APPLIED. FOR ON THE DAY THE WATER METER OR OTHER UM= : SERVICE COWgECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND10R SERVICE.
CUSTOMER SIGNATURE PA442-f, SOCIAL SEC/FED ID —
NAME OF SPOUSE SPOUSE SOCIAL -
OFFICE USE ONLY n
DATERECEIVED R•ok CASH Ei( / L RECEIVED BY �—��