HomeMy WebLinkAboutWater & Sewer ApplicationATER I
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME —sr-
ACCT. ## ' ..!
SERVICE ADDR
SAME DAY FEE SUBDNIS
OVERTIME FEE
METER INSTAL
CFC/WATER
j FPUA CFC
CFC/SEWER
GUAR. REV.
j LATERAL
I, TOTAL
BILLING
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.66 Plat # 4
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BLOCK
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EMAIL ADDRESS:
PHONE 6 )) 73,3` /)/ / 1 MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to render water and/or sewage disposal
servicesto the premises described above in accordance with the Utilities present orfuture rates, rules and
regulations, which by reference are made a part of this contract: Applicantagrees to pay Utility promptly for
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 UTILITY SERVICE
APPLIED FOR ON THE - DAY THE WATER METER OR OTHER ;UTII= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY -REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METERAND/OR SERVICE.
ma�.w SOCIAL SEC/.FEED ID
CUSTOMER SIGNATURE. [ •�'. / _
NAME OFSPOUSE i SPOUSE SOCIAL'
OFFICE USE ONLYn�
DATE RECEIVED �� ' CASH {H`FEt?K�#' RECEIVED BY
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