HomeMy WebLinkAboutWater & Sewer New Customer ApplicationS.; .;1!�L
WATER COMM
SEWER - RES
�J METER SZ. M/F
IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
q' T' OD METER INSTAL
�'973_ UQ CFC/WATER
FPUA CFC
00. CFC/SEWER
GUAR. REV.
LATERAL
�[ �00 TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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NAME A1-JA1t',7j'7-
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ACCT. # 0?
SERVICE ADD
SUBDIVISION YID LOT / / BLOCK
BILLING ADDRESS —J60 rl 3Q-!!Z,3
EMAIL ADDRESS:
PHONE It_Q 1 - 0 �� 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 UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTI11TY 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
OFFICE USE ONLY
DATE RECEIVED CASH CHECK# RECEIVED BY