Loading...
HomeMy WebLinkAboutWater & Sewer New Customer ApplicationWATER SEWER �J g METER Sz. COMM RES M/F IRR $ r Dr) SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE 41� T' OD METER INSTAL 3173_ U� CFC/WATER FPUA CFC 3 .a©. CFC/SEWER GUAR. REV. LATERAL $U 3I TOTAL ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION Ivia'.-Air 17�We-r A1M,,P1'r /r,-L- ACCT. If SERVICE ADDRESS 3a� � SUBDIVISION1 Ke-' LOT BLOCK 3 BILLING ADDRESS 139A) 64q ��er2e, . Fl &;2�3 EMAIL ADDRESS: PHONE # q65- 8�9 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 UTIIXTY SERVICE 1 Lr I APPLIED FOR ON THE DAY THE WATER METER OR OTBER UTILMY SERVICE CONNECTION IS INSTALLED AT 1 • I 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 OFFICE USE ONLY ,L DATE RECEIVED �� I CASH CHECK # RECEIVED BY gJ12 j&