HomeMy WebLinkAboutSewage New Customer ApplicationATER I
SEWER
5�
METER SZ.
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NP
`LIU ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
;Y, NEW CUSTOMER APPLICATION
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OMM i
RES NAME
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M/F ACCT. #
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IRR
$ SECURITY DEP
jSERVICE FEE
_ SAME DAY FEE
l OVERTIME FEE
` METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 1 '7 TOTAL
0
SERVICE ADDRESS
LOT V
SUBDIVISIONLPlat # 4 � �
4
BILUNGAODRESS.�D
BLOCK
,qzq 12
EMAILADDRESS:. �`
33
PHON_ ET�'J [ / ' MOVE IN/CLOSING DATE
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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, 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.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE ORTRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL- BEGIN PAYING BASE FACILITY CHARGES FOR THE MMXIY SERVICE
APPLIED ;FOR ON THE DAY THE WATER METER OR OTHER ;UTn= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY -REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METERAND/OR SERVICE.
CUSTOMER SIGNATURE
SOCIAL SEC/FED ID
NAME OF SPOUSE SPOUSE SOCIAL'
J OFFICE USE ONLY— -
DATE RECEIVED r` �� CASH a4ac rn� RECEIVED BY ��