HomeMy WebLinkAboutWater & Sewer New Customer Application4 t:E ST LUCIE COUNTY WATER & SEWER -DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
WATER
COMM
SEWER
�-
RES
Sg METERSZ.
M/F
IRR
$ D4 '
SECURITY DEP
_
SERVICE FEE
-
SAME DAY FEE
OVERTIME FEE
TQt
METER INSTAL
CFC/WATER
FPUA CFC
•OQ. CFC/SEWER
-. 'D� - GUAR. REV.
LATERAL
$� TOTAL
NAME /&d-%�.r I�W-f
Arm"&'r r-1,
ACCT. # /S,5-7 Q w— vr) r7l
SERVICE ADD
A- (- r
SUBDIVISION _ i�%� LOT eV BLOCK
BILLING ADDRESS � 'i ��l�C� � ,�j(,� 66W&Fee-e,IrK 3Q50,3
EMAIL ADDRESS:
PHONE # 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 NQN NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTII1Ty SERVICE
U APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTII�Ty SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WAN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
ER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
DATE RECEIVED
a�
OFFICE USE ONLY j
CASH CHECK # � ��� / RECEIVED BY
a 2&i�Ay