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HomeMy WebLinkAboutWater & Sewer New Customer ApplicationWATER 1L SEWER 5g METER SZ. r, L-L,! c�uL. COMM RES M/F IRR SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE 7"J �OD METER INSTAL 31273_ UQ CFC/WATER FPUA CFC •D©. CFC/SEWER 6Q4�C-JLI 4P GUAR. REV. I LATERAL TOTAL L� ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION NA 1Q�r M E 1AWS 4,M.P"r F-Z- ACCT. # 85-1 ' Q -- Y1 ' ( ) SERVICE 533 SUBDIVISION ,7e, LOT /� BLOCK BILLING ADDRESS EMAIL ADDRESS: PHONE # �t�V J ��'7 7'` MOVE IN/CLOSING DA 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 promptlyfor 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 UMITY SERVICE APPLIED FOR ON THE DAY THE' WATER METER OR OTHER UT ny . 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 ��1� DATE RECEIVED_ `_ CASH CHECK# o]7779� RECEIVED BY Q 1'2'70 3