HomeMy WebLinkAboutNew Customer ApplicationL'� � _j .( �1L ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
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NEW CUSTOMER APPLICATION
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ATER I OM1
SEWER I I ✓.. RES
METER SZ, M/F
w iRR
$ (�i. SECURITY DEP
0
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
{ j FPUA CFC
CFC/SEWER
1 GUAR. REV.
LATERAL
$ / i ! TOTAL
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ACCT. # 04 / (/
SERVICE ADD
SUBDIVISION6?lic— Plaf # 4
BILUNGADDRESS v C AI — cfJ%2l U
LOT
BLOCK
13:;�194_)'1
EMAIL ADDRESS:. � � 2 �
PHONE gL� ML3_ / I / 0� MOVE IN/CLOSING DATE
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
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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTUXIY SERVICE
APPLIED 1 FOR ON THE DAY THE WATER METER OR OTHER ;UTf= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY • REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METERAND/OR SERVICE.
CUSTOMER SIGNATURE I '. `� �% ,,a. ...... .. SOCIAL SEC/FED ID _` ,5 caul % ''
NAME OFSPOUSE J SPOUSE SOCIAL-
/ OFFICE USE ONLY_=
DATE -RECEIVED �r CASH CJEif'' / ��� RECEIVED BY
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