HomeMy WebLinkAboutWater & Sewr New Customer Application��J+L WATER
1L SEWER
�g METER SZ.
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COMM
RES
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
, 00 METER INSTAL
3173_ UD CFC/WATER
FPUA CFC
3 •00. CFC/SEWER
GUAR. REV.
/ LATERAL
$ �[ TOTAL
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME /&��
ACCT. # 8�5-
SERVICE
9
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SUBDIVISION v%e-, LOT BLOCK
BILLING ADDRESS `��6uly obqlem
EMAIL ADDRESS: - p
PHONE It �l t„J ' 0 _ 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 TBE UTILF.Cy SERVICE
APPLIED FOR ON TBE DAY THE WATER METER OR OTHER UTII,iTY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
7 av OFFICE USE ONLY
DATE RECEIVED �3� CASH CHECK # RECEIVED BY
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