HomeMy WebLinkAboutSeweage Customer ApplicationST'LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
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Q, NEW CUSTOMER APPLICATION
LIRM
V XATER OMM
VSEWER ES
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METER SZ. M/F
IRR
$ .SECURITY DEP
SERVICE FEE
SAME DAY PEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
I CFC/SEWER
GUAR. REV.
J LATERAL
I TOTAL
NAME \�"�
ACCT,
SERVICE ADDRESS_
SUBDIVISION
BILLINGAODRESS.
EMAILADDRESS'
PHONE#(L5Q 733- ?,12�; mbvt 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 t ' he Utilities present or future rates, rules and
regulations, which by reference are made'a part of 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.
7
Plat # 4
i LOT BLOCK
lx� At A n 161W Az �910 9
-APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING'BASE FACILITY CHARGES FOR THE LMLITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR oTBER.uTn= smviq CONNECTION is INSTALLED AT
APPLICANTS PROPERTY- REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METERANDIOR SERVICE.
CUSTOMER SIGNATUREI j <' SOCIALSECIPED ID
NAME OFSPOUSE I SPOUSE SOCIAL'
OFFICE USE ONLY:
P LC —
DATE -RECEIVED __2L CASH RECEIVED BY