HomeMy WebLinkAboutWater & Sewer New Customer ApplicationWATER
SEWER
�g. METER SZ.
COMM
RES
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
�OO
METER INSTAL
CFC/WATER
FPUA CFC
3 .00.
CFC/SEWER
�C—
GUAR. REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME �Q.�aJ' �iarrr�C r/�
ACCT. # 1s51IQ �10 9
SERVICE
6 /3/vd.
SUBDIVISION LOT 33 BLOCK \J
BILLING ADDRESS ZOO 6Uq &&110LLf�Ly� �XO�
EMAIL ADDRESS: p /�
PHONE # %5— O'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 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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTBER UTILITY SERVICE CONNECTION IS INSTALLED AT
1 • 1 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
�J OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY