HomeMy WebLinkAboutWater & Sewr New Customer ApplicationS1, LL! UL
'✓ WATER
COMM
SEWER
RES
METER SZ.
M/F
0/
IRR
$ -R5LJV
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
DV METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
/
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. #
SERVICE ADDRE!
SUBDIVISION
BILLING
EMAIL ADDRESS:
P 713
f
LOT J BLOCK_
PHONE #i0 - F139 V 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.
X APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR ME UTILTIY SERVICE
a APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITy SERVICE CONNECTION IS INS
TALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WREN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
DATE RECEIVED OFFICE USE ONLY //--
CASH CHECK #%�Q RECEIVED BY