HomeMy WebLinkAboutNew Customer Application Water & SewerA'rER. MM
SEWER ✓ RES
METER SZ. M/F
IRR
0
$ SECURITY DEP
SERVICE FEE
SANIE-DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER . .
FPUA CFC
CFC/SE%MER
GUAR. REV.
.nn 'LATERAL
$y TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU).
NEW CUSTOMER APPLICATION
AME .',D4
ACCT. #lJ
SERVICE
Fort Pierce, FL 34945
SUBDIVISIONc.�iOi�;7 d� LOT / BLOCK
DRE %7iJlJ /1 �i� - � i/C N / eG7 Q9,0 /
BILLING AD SS L C.r-G � _ _ ___
EMAILADDRESS..DMPARRIIN/�O�}_17RHORTON.COM
.. PHONE dC% ,! 1 / 3_ ,� 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 partof.this contract: Applicant agrees to pay Utility promptlyfor
such:services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
ElAPPLICANT AGREES THAT .APPLICANT WDJL BEGIN PAYING BASE FACiiM CHARGES FOR THE UMXU SERVICE
APPLIED FOR ON ..TIIE DAY. THE: WATER METER OR. OTHER VM= . SERVICE CONNECTION IS INSTALLED AT
APPIWANI T'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS Ui=ING THE METER ANDIOR SERVICE::
CUSTOMER SIGNATURE k;t� SOCIAL SEC/FED ID
NAME OF SPOUSE SPOUSE SOCIAL•
OFFICE USE ONLY
DATE RECEIVED � C �e;�n CASH_ E"EErr 174v RECEIVED BY � :�