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HomeMy WebLinkAboutWater & Sewer New CustomernApplicationi� WATER ]L SEWER O METER SZ. �`L; L ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) �� NEW CUSTOMER APPLICATION COMM �- RES M/F IRR SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE �QQ METER INSTAL 73. 0j) CFC/WATER FPUA CFC 3 .Q©, CFC/SEWER GUAR. REV. LATERAL $ . 00 TOTAL NAME AdVPTT 62 A1M,,Prq- F-�, ACCT. SERVICE ADDRESS _511Q r SUBDIVISION . I/%�—' LOT C BLOCK BILLING EMAIL ADDRESS: .�0 6U &ems . rl �3 PHONE It qO — O tb:�Q T 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 UTHM SERVICE APPLIED FOR ON THE DAY TIM WATER METER OR OTHER LTrHm Y 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 '7' 30 -c�L/ CASH CHECK # RECEIVED BY (,�