HomeMy WebLinkAboutWater & Sewer New Customer applicationV WATER
SEWER
METER SZ.
Y, LL.cLIL - ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
f9i.
'� NEW CUSTOMER APPLICATION
COMM
RES
M/F
IRR
0/ LJV
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
DD METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
l Q LATERAL
LDOU TOTAL
ACCT. # �5i�7` a r 33o
SERVICE AD
SUBDIVISIO
BILLING
00
LOT 9BLOCK
— L—
EMAIL ADDRESS: Q
PHONE ft./05 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 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 NON NEGOTIABLE OR TRANSFERABLE.
aAPPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECITON 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
i OFFICE USE ONLY �fJ
DATE RECEIVED ! oil CASH CHECK# `/ / RECEIVED BY&k4 v`