HomeMy WebLinkAboutWater & Sewage applicationELI"
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ST* LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
.NEW CUSTOMER APPLICATION
NAM
ACCT. # *
SERVICE ADDRI
SAME DAY PEE I SUB
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
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I GUAR. REV.
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TOTAL
LOT BLOCK
EMAIL ADDRESS:.
PHONE44/Q)) 7:53— 91 2C),.: MOVE IN/CLOSING DATE
This application hereby requests and auth P'Hzes the Utility to render water and/or sewage disposal
servicesto 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
suchservicesin accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERA: kE.
BILLINOACORtSS
Pld:t; # 4
-APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING :BASE FACILITY CIELARGES FOR THE UTHIrY SERVICE
APPLIED if -FOR ON THE DAY THE WATER METER OR OTHER :UTILITY SERVICE. CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY -REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE,
SOCIAL SEC/FED I D all
NAME OFSPOUSE SPOUSE SOCIAL'
DATE-RECE
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