HomeMy WebLinkAboutSewage New Customer Application.... _.......................................... ..........._................. ... .... .... .
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L L` !.t 1fL" ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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SEWER i RES
NAME ! +
ACCT.#
c.J METERSZ. I M/F
IRR
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SECURITY DEP
SERVICE ADDRESS r EI ulxk
jSERVICE FEE
SUBDNISION�ID& Plat # 4 I LOT ` BLOCK /
I. SAME DAY FEE
OVERTIME FEE
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INSTAL
METER AL '
$ILLING.AODRESS: i�.Jv ( G/I�
? CFC/WATER
EMAILADDRESS:.
FPUA CFC
PHONE C )) lcJ — / ), / . MOVE IN/CLOSING DATE
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! CFC/SEWER
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I GUAR. REV.
This application hereby requests and authorizes the Utility to render water and/orsewage disposal
services to the premises described above in accordance with the Utilities present or future rates, rules and
i LATERAL
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.
$ i i TOTAL
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CUSTOMERS DEPOSITS ARE NON NEGOTIABLE ORTRANSFERABLE.
APPLICANT AGREES THAT APPLICANT. WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTnXrY SERVICE
APPLIED iFOR ON THE DAY THE WATER METER OR OTHER .UTII = SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY - REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METERANDIOR SERVICE.
CUSTOMERSIGNATURE�- SOCIAI;SECIFED ID o�T
NAME OF SPOUSE SPOUSESOCIAL,
j OFFICE USE ONLY:
DATE -RECEIVED all 1 ` e� CASH etmm RECEIVED BY e