HomeMy WebLinkAboutWater & Sewer ApplicationTER
SEWER
METER SZ... � 1
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OMM:
ES
M/F
NAME
ACCT. # '
ST'LUCIE COUNTY WATER & SEINER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
IRR
. SECURITY DEP SERVICE ADDRESS
SERVICE FEE I
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/%VATER
FPUA CFC
CFt/SEWER
GUAR. REV.
i II LATERAL
TOTAL
U D 1 /Y�GIr Cs
LOT BLOCK
Az -r- N 9019
EMAIL ADDRESS:.
PHONE mbVE 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. Aoplica nt agrees to pay Utility prom ptlyfor
such -services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
Plaf # 4
131'LLINGAEORESS.
-APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTR= SERVICE
APPLIED IF'OR ON THE DAY THE, WATER METER OR omkzmm SERVICE - CONNECTION is INSTALLED AT
APPLICANT'S PROPERTY -REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE! i SOCIAL; SECJFLD ID -73 —6?4z4-,P64& 7
NAME OF SPOUSE
SPOUSE SOCIAL,
OFFICE USE ONLY.
DATE•RECEIVED i CASH Z14ficr# RECEIVED BY