HomeMy WebLinkAboutNEW RESIDENTIAL SERVICE APPLICATION%SPRINKLE,,.,._ 'STEM ❑YES w; NO s, CUSTOMER NO.
CITY OF PORT ST LIdCIE�
BYRASS §,OFTENER ❑ YES ❑ No fi UTILITY `Sll'STEMS ®EPb4RTMEIVT
/�� .i' � ,``\� ��'� LOCATION NO.
NEW RESID �\SERVIGE-APPLICATION X-STREET
O\V.,N E R/TENANTS: ; n
CUSTOMER NO:
PHONE NO: CC IT SG
ACCOUNT NAIVE: I) AT G\ � 1,� WATER= lant Capacity: (ONE (1) ERC) $ 847.00
(4390003-343353-00000)
SERVICE ADDRESS: ►"c� nx\I-' �" $� �!°r� e � � -� ' u
_ - NO SAD/USA LINE FEE ($478.00) $ (4390003-343453-00000)
PORT ST. LUCIE, FL ZIP: — SAD/USA-3/4" Meter Fee ($250.00) $ (4390003-343355-00000)
NILING ADDRESS: SAME AS ABOVE ❑
CITY: `'., STATE:
HOME TEL: ZIP: !l
BUSINESS TEL: `, SOC SEC NO.:
CYCLE
ROUTE:
LOT(S): BLK:
TYPE OF SERVICE REQUESTED:
NON SAD/USA-3/4" Meter Fee ($250.00) $ a -O (4310003-343352-00000)
TOTAL: $ 1
SEWER- Plant Capacity: ' (ONE (1) ERC: $ 1;064:00— (4390003-343553-00000)
NON SAD/USA LINE FEE ($373.00) $ (4390003-343455-00000)
Grinder Installation: ($2184.00) $ (4390003-343555-00000)
SEQ: LPS Installation Fee: ($2184.00) $ (4310003-343557-00000)
SEC: INJy' (- �' ' r SEPTIC SERVICE: ($447.00) $ (4890003-343555-00000)
TOTAL: $
VATER: SAD/USA PHASE NO. NONfSAD/USA SECURITY DEPOSIT WATER: $ 25.00 (4310000-220331)
SEWER:_ GRINDER PUMP ❑ SAD/USA PHASE NO. SECURITY DEPOSIT SEWER: $ _ 45-00— (4310000-220331)
GRAVITY ❑ LOW PRESSURE ❑ RECORDING FEES: $ (4310000-220000
(10 YEAR PAYBACK ONLY) )
NP SP WP LESS DEPOSIT & RECORDING FEES: $ ( ) ( )
Estimated installation times following the receipt of this completed application is TOTAL AMOUNT DUE: $� hodf3
approximately: weeks for water and weeks for sewer. RECEIPT NO.
�% DATE PAID RECEIVEY BY
UTILITY will provide water and/or sewer service upon payment of the applicable connection charges and compliance with the Terms and Conditions listed on the back of this Service Application.
The Utility policies provide for a water and/or wastewater plant capacity allocation_of two -hundred and ffty_(gW)_gall_ons=per day_ per_equivalent-residential-connection-(ERC—).- _
- - The-Utility=will=not-be-obligated-to provide —capacity of servic_e in excess of that allocation and may require consumers to curtail use which exceeds such allocated capacity.
The Terms and Conditions Regarding Water and Wastewater service, adopted by the City Council of the City of Port St. Lucie, are listed on the back of this service application.
I have read and acknowledge receipt of this service Agreement by signature below.
DISTRIBUTION: White -Utility Pink -Finance Yellow -Customer
Customer Signature
.4r
Date
GENERAL TERMS AND CONDITIONS REGARDING WATER AND WASTEWATER SERVICE v"'
1. Signed Application Required Water and wastewater service capacity may be furnished only after a signed application or agreement and payment of the applicable water and wastewater capital charges are accepted by the
City. The conditions of such application or agreement are binding upon the customer as well as upon the City. A copy of the application or agreement for water and wastewater service accepted by the City will be finni.,hed
to the applicant. The applicant shall fimmish to the City the correct name and street address and lot and block number at which water and wastewater service is to be rendered.
2. Withholding Service The City may withhold or discontinue water and/or wastewater service rendered under application made by any member or agent of a household, organization, or business unless all prior indebtedness to
the City of such household, organization, or business for water and wastewater service has been settled in full in accordance with City policy. Service may also be discontinued for any violation made by the customer, of any
rule or regulation set forth in the policy and procedures adopted by the City Counsel of the City of Port St. Lucie.
3. Limitation of Use Water and Wastewater service purchased from the City shall be used by the customer only for the purpose specified in the application for water and wastewater service.
4. Continuity of Service The City will at all times use reasonable diligence to provide continuous water and wastewater service and,.having used reasonable diligence, shall not be liable to the customer for failure or interrup-
tion of continuous water and wastewater service. The City shall not be liable for any or omission caused directly or indirectly by strikes, labor'trouble, accidents, litigation, breakdowns, shutdowns for emergency repairs or
adjustments, acts of sabotage, enemies of the United States, Wars, United States, State, municipal or other governmental interferences, acts of God or other causes beyond its control.
5. Type and Maintenance The customer's pipes, apparatus and equipment shall be selected, installed, used and maintained in accordance with standard practice and shall conform with the rules and regulations of the City. The
City shall not be responsible for the maintenance and operation of the Customer's pipes and facilities. The Customer expressly agrees not to utilize any appliance or device which is not properly constructed, controlled aj
protected, or which may adversely affect water and wastewater service provided by the City. The City reserves the right to discontinue or withhold water and wastewater service to such apparatus or device.
6. Change of Customer's Installation No changes or increases in the customer's installation, which will materially affect the proper operation of the pipes, mains, or stations of the City, shall be made without written consent of
the City. The Customer shall be liable for any change resulting from a violation of this rule. .
7. Protection of CWs Property The Customer shall exercise reasonable diligence to protect the City's property on the Customer's premises and shall knowingly permit no one, but the City's agent or persons authorized by law,
to have access to the City's pipes and. appurtenances. In event of any loss or damage to property of the City caused by or arising our of carelessness, neglect, or misuse by the customer, the cost of making good such loss
or repairing such damage shall be paid by the customer.
8. Access to Premises The duly authorized agents of the City shall have access to the premises of the Customer for the purpose of installing, maintaining, inspecting, or removing the City's property or the performance under or
termination of the City's agreement with the customer and under such performance shall not be liable for trespass. Areas where such facilities are located will be kept free of shrubbery, trees, fences, interference from pets
and other obstructions.
9. Bilk Periods Bills for water and wastewater service will be rendered monthly as stated in the rate schedule and shall become due when rendered and be considered as received by the Customer when delivered or mailed to
the water and/or wastewater service address or some other place mutually agreed upon. Non -receipt of bills by the customer shall not release or diminish the obligation of the customer with respect to payment thereof.
-10. Delinquent Bills Bills are due when rendered and become delinquent if not paid within twenty (20) days after the bill has been mailed or presented to the Customer for payment. Water and wastewater service may then be
discontinued only after a written notice has been mailed or presented within (5) working days to the Customer of the delinquency in payment. Water and wastewater service shall be restored only after the City has
received payment for all past -due bills and reconnect charges from the Customer. There shall be no liability of any kind against the City for the discontinuance of water and wastewater service to a Customer for that
Customer's failure to pay the bills on time. Partial payment of a bill of the water and wastewater service rendered will not be accepted by the City, except by the City s agreement thereof.
-i 1. Payment of Water and Wastewater Service Bills Concurrently When both water and wastewater services are provided by the City, payment of any wastewater service bill rendered by the City to a customer shall not be
accepted by the City without the simultaneous or concurrent payment of any water service bill rendered by the City. The City may discontinue both water service and wastewater service to the Customer's premises for non-
payment of the wastewater service or water service bill or if payment is not made concurrently. The City shall not reestablish or reconnect wastewater service and/or water service until such time as all wastewater and wat
service bills and all charges are paid.
12. Tax Clause Any tax which may be levied upon the City's water or wastewater system shall not be incorporated into the rate for water or wastewater service but shall be shown as a separate item on the City's bills to its cus-
tomers receiving service.
13. Change of Occupancy When a change of occupancy takes place on any premises supplied by the City with water and wastewater service, written notice thereof shall be given at the office of the City not less than three (3)
days prior to the date of change by the outgoing customer. The outgoing customer shall be held responsible for all water and wastewater service rendered on such premises until such written notice is so received by the City
and the City has had reasonable time to discontinue the water and wastewater service. However, if such written notice has been received, the application of such a succeeding occupant for water and wastewater service will
automatically temrinate the prior account. The Customer's deposit may be transferred from one service location to another, if both locations are supplied water and wastewater service by the City. The Customer's deposit may
not be transferred from one name to another. Notwithstanding the above, the City will accept telephone orders, for the convenience to its Customers, to discontinue or transfer water and wastewater service from one service
address to another and will use all reasonable diligence in the execution thereof. However, oral orders or advice shall not be deemed binding or be considered formal notification to the City.
14. Unauthorized Corrections Connections to the City's water and wastewater system for any purpose whatsoever are made only by employees of the City. Any unauthorized connections to the Customer's water and wastewater
service shall be subject to immediate discontinuance without notice. Water and wastewater service shall not be restored until such unauthorized connections have been removed and until settlement is made in full to the City
for all water and wastewater service estimated by the City to have been used by reason of such unauthorized connection.
15_Adjustment of Bills When a Customer has been overcharged or undercharged as a result of incorrect application of the rate schedule, incorrect reading of a water meter, or other similar reasons, the amount may be credited
- -orilled to-the-Cu bstomer in=accordance-witli thee policies-6f-the City.
16. Payment of Security De —posit This payment is to guarantee any and all indebtedness for water and/or wastewater service which may be, or become due, to the City of Port St. Lucie. Cash deposits received by the City shall
be held in a non -interest bearing account. Cash deposits will not be refimded until the customer has timely paid (without any late charges) all charges for water and/or wastewater services for a period of thirty-six (36)
consecutive months. Any deposit to be refunded will be applied to the next bill issued and shall be a credit against any charges due.
-SPRINKLER.. SYSTEM
BY0ASS$017ENER
❑ YES U NO
❑ YES ❑ NO
OWNER/TENANTS:
CUSTOMER NO:
PHONE NO:
ACCOUNT NAME:
SERVICE -ADDRESS:
PORT ST. LUCIE, FL ZIP: .
� CUSTOMER NO.
CITY OF PORT ST. LUCIi� TIL-ITY<Sk, ,STEMS DEPARTMENT
/' a °a �. LOCATION NO.
NEW RESIDENT VIG APPLICATION
X-STREET
CC IT SG
` - \ �` �tWAl'ER-Plant Capacity: (ONE (1) ERC) $ 847.00 (4390003-343353-00060)
}- I �� ''�= NON AD/USA LINE FEE ($478.00) $ j 3 '(4390003-343453-00000)
SLING ADDRESS: SAME AS ABOVE El
CITY: - STATE:
HOME TEL: ZIP: �tl
BUSINESS TEL: ` r3 — SylR SOC SEC NO.:
CYCLE: ROUTE:
LOT(S): 'a BILK:
SAD/USA 3/4' Meter Fee -($250.00) $ (4390003-343355-00000)
NON SAD/USA-3/4' MeterFee($250.00). $ t (4310003-343352-00000)
TOTAL: $ I 1�;:'7�;' "'t
SEWER- Plant Capacity: " (ONE (1) ERC: $ '1;064M— (4390003-343553-00000)
NON SAD/USA LINE FEE ($373.00) $
Grinder Installation: ($2184.00)
SEQ: LIPS Installation Fee: ($2184.00)
SEC: tt"i"-. SEPTIC SERVICE: ($447.00) .
TYPE OF SERVICE REQUESTED:
WATER: SAD/USA PHASE NO. NON tAD/USA -a
OLNER: GRINDER PUMP ❑ SAD/USA PHASE NO.
GRAVITY ❑ LOW PRESSURE ❑
TOTAL
SECURITY DEPOSIT WATER:
SECURITY DEPOSIT SEWER:
(4390003-343455-00000)
(4390003-343555-00000)
(4310003-343557-00000)
(4390003-343555-0,0000)
$ - 25 00 (4310000-220331)
$ 45400-- (4310000-220331)
RECORDING FEES: $
. . (10 YEAR PAYBACK, ONLY) (4310000=220000 )
NP SP WP LESS DEPOSIT & RECORDING FEES: $ ( ) ( )
Estimated installation times following the receipt of this completed application is TOTAL AMOUNT DUE: $
approximately: weeks for water and weeks for sewer. RECEIPT NO.
DATE PAID RECEIVED` BY
UTILITY will provide water and/or sewer service upon payment of the applicable connection charges and complian"c`e with thSe�ler"in'snd Conditions listed on the back of this Service Application.
The Utility policies provide for a water and/or wastewater plant capacity allocation of two -hundred and fifty (250) gallons per day per equivalent-residential-connection-(ERC).---- - —
The -Utility -will -not -be -obligated -to provide capacity of -service -in excess of -that allocation and may require consumers to curtail use which exceeds such allocated capacity.
The Terms and Conditions Regarding Water and Wastewater service, adopted ey the City Council of the City of Port St. Lucie; are listed on.the back of this service application.
I have read and acknowledge receipt of this service Agreement by signature below.
DISTRIBUTION: White -Utility Pink -Finance Yellow -Customer
Customer Slanature
nntp