HomeMy WebLinkAboutWater & Sewer New Customer ApplicationWATER
SEWER
�J g METER SZ.
St, - L.-E R-
NEW ST LUCIE COUNTY WATER-& SEWER. DISTRICT (SLCU)
CUSTOMER APPLICATION
COMM
�L-- RES
M/F
IRR
AD 0� SECURITY DEP
r
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
93 Od METER INSTAL
,3173_ UQ —CFC/WATER
FPUA CFC
CFC/SEWER
A C GUAR. REV.
LATERAL
Jl TOTAL
/&'a.�nr ArAa-Prr
/ti7,5—V v -
SERVICE ADDRESS 15
Jr
SUBDIVISIONjz.A�-c3zU/�e--- LOT lJ BLOCK
BILLING
EMAIL -ADDRESS: -
PHONE #_�.V " !J'7 7 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 orfuture 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 OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UIUM SERVICE
U APPLIED FOR ON TIE DAY THE' WATER METER OR OTHER UTHITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
SOCIAL SEC/FED ID
NAME OF SPOUSE SPOUSE SOCIAL
r � OFFICE U5E ONLY �� / e�
DATE RECEIVED ` �P ' t CASH CHECK #�i��v�c�-I� RECEIVED BY
i2]