HomeMy WebLinkAboutSewage New Customer ApplicationATER
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME 'Dae 11V ��1j
ACCT.#
SERVICE ADDRESS
SUBDIVISIONt eedZ'd6C_ Plat # 4 LOT BLOCK
BIWNG ADDRESS . �i�/�/ /yG°� �LJ�611z,—_ AC, / jh 4 /—Z �9, 9
EMAIL ADDRESS:. 2 �j
PHONE �) 753J �� / c 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 prom ptlyfor
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 FACILITY CHARGES FOR THE UTHM SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTII.TTY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY -REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE RECEIVED ` I CASH CRECW'* 1 " l� RECEIVED BY
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