HomeMy WebLinkAboutWater & Sewer New Customer ApplicationU. 3 ST LUCIE COUNTY WATER & SEWER -DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ATER i
OMM;
SEWER
: ✓... RES
5TMETER SZ.
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M/F
$
IRR
SECURITY DEP
NAME_
ACCT. # / 11 U VU
SERVICE ADDRESS
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I j SERVICE FEE
TSAME DAY FEE
SUBDIV
OVERTIME FEE `
METER INSTAL 'BILLING
CFC/WATER
j FPUA CFC
I ! CPC/SEWER
j GUAR. REV.
j LATERAL
$ 1 ! TOTAL
Plat # 4
LOT &,K,tga�p
BLOCK
,94 9
EMAIL ADDRESS:.
PHONE ic/� J tom/— / 1 r 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 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 TBE UTIrA SERVICE
APPLIED i FOR ON THE DAY THE WATER METER OR OTHER :U'T1= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY -REGARDLESS.OF WHEN APPLICANT STARTS UTILIZING THE METERAND/OR SERVICE.
CUSTOMER SIGNATURE! % a Yam.
_.. SOCIAL SECjFED ID '?:SSI�o'rfi
I _
NAME OF SPOUSE SPOUSE SOCIAL•
i
OFFICE USE ONLY
DATE -RECEIVE ' CASH C / �'c� RECEIVED BY
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