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APPLICATION FOR SERVICE
<br /> ► PASCO COUNTY UTILITY SERVICES
<br /> 7536 STATE STREET, SUITE 118 �72�� 84�-$131 NEW PORT R�CHEY
<br /> P.O BOX 2139 (813) 235-6012 LAND O'LAKES
<br /> NEW PORT RICHEY, FL 34656 (352) 521-4285 DADE CITY q�,# E �C�i��
<br /> FAX (727) 847-8972
<br /> I, THE UNDERSIGNED, REQUEST THAT WATER AND/OR SEWER SERVICE BE TURNED ON AT THE BELOW
<br /> PREMISES, TO BE SUPPLIED THROUGH A METER,AND I AGREE TO PAY ALL MONTHLY BILLS WITHIN FIFTEEN
<br /> (15) DAYS, AT THE ESTABLISHED RATES, FOR ALL WATER AND/OR SEWER SERVICE RECEIVED AND/OR
<br /> CONSUMED FOR THE PERIOD FOR WHICH THE BILL IS RENDERED. I FURTHER AGREE TO OBSERVE
<br /> ALL RULES AND REGULATIONS PROMULGATED BY PASCO COUNTY UTILITY SERVICES AND WILL NOT
<br /> PERMIT ANY ADDITIONAL TAPS OR LINES TO BE MADE OR ATTACHED TO THE WATERLINES ON THE BELOW
<br /> PREMISES. IN ADDITION, I UNDERSTAND THAT THE SERVICE BEING APPLIED FOR BELOW IS TO SERVICE
<br /> ONLY THE PREMISES LiSTED ON THIS APPLICATION, AND ANY NEW STRUCTURES ON SAID PROPERTY
<br /> CANNOT BE PROVIDED WITH WATER/SEWER SERVICE THROUGH THE SAME WATER METER.
<br /> IT IS AGREED THAT ANY AUTHORIZED AGENT OR EMPLOYEE OF PASCO COUNTY UTILITY SERVICES SHALL
<br /> HAVE ACCESS TO THE BELOW LISTED PREMISES AT ANY AND ALL REASONABLE HOURS FOR THE PURPOSE
<br /> OF CONDUCTING NORMAL BUSINESS WHILE WATER AND/OR SEWER SERVICES ARE BEING SUPPLIED
<br /> TO THE SAID PREMISES, DESCRIBED BELOW, WITHOUT BEING LIABLE FOR EITHER PERSONAL OR
<br /> PROPERTY DAMAGES OF ANY KIND WHATSOEVER. IT IS FURTHER AGREED THAT IF THERE IS AN UNPAID
<br /> BALANCE DUE ON MY ACCOUNT FOR ANY WATER AND/OR SEWER SERVICE CONNECTION, IT MAY BE
<br /> TRANSFERRED TO THIS ACCOUNT FOR IMMEDIATE PAYMENT. IN THE EVENT OF NONPAYMENT OF ANY
<br /> WATER AND/OR SEWER BILL DUE FOR THIS OR ANY OTHER CONNECTION, ALL WATER AND/OR SEWER
<br /> SERVICES CAN BE DISCONNECTED BY UTILITY SERVICES AND BEFORE SAID SERVICE IS RECONNECTED,
<br /> ALL OUTSTANDING BILLS MUST BE PAID IN FULL IN ADDITION TO A RECONNECTION FEE AT THE
<br /> PREVAILING RATE. THE RECONNECTION FEE IS PAYABLE IN ADVANCE, BEFORE SERVICE IS RESTORED,
<br /> EVEN IF METER HAS NOT BEEN REMOVED OR DISCONNECTED.
<br /> IF APPLICABLE: I AGREE TO PAY ANY AND ALL FEES BEFORE THE WATER IS TURNED ON AT THE
<br /> PREMISES. I WILL PAY ALL DAMAGES TO ANY OF UTILITY SERVICES PROPERTY AND/OR METERS, AND IF
<br /> NOT PAID UPON PRESENTATION OF BILL, THE WATER MAY BE DISCONTINUED.
<br /> THIS CONTRACT REMAINS IN FULL FORCE AND EFFECT UNTIL WRIl�'EN NOTICE HAS BEEN RECEIVED
<br /> BY PASCO COUNTY UTILITY SERVtCES TO DISCONTINUE SERVICE. THE DEPOSIT MADE WITH THIS
<br /> APPLICATION WILL BEAR NO INTEREST AND WILL BE APPLIED TO THIS ACCOUNT UPON WRITTEN NOTICE
<br /> TO DISCONTINUE SERVICE, OR AFTER APPLICANT HAS FULFILLED TWENTY-FOUR (24) MONTHS OF
<br /> CONSECUTIVE SERVICE WITH NO LATE PAYMENTS OR DISHONORED CHECKS. PASCO COUNTY UTILITY
<br /> SERVICES IS PERMITTED TO FILL IN THE BLANK(S) FOR THE FOLLOWING PROPERTY, TO-WIT
<br /> ACCOUNT NO.: '���;� -f,'.c -fa=1.;`__c}._14
<br /> DEPQ��TDATE: ��'���}`�°��-���
<br /> NAME: ��' ��:tt�h�' �LCi^[DA � �_t:: �'.,.,�' _,.° '� t,` j - f r�_� �t� C _ -{,", - I�
<br /> (�s� DEPOSIT FEE: - ���
<br /> (FIRS� (INITIAL)
<br /> SERVICE
<br /> ADDRESS: 1 �'�`'- "'�"'+��,'�.Y F{Li_!FF LF
<br /> SUBDIVISI(�1, ETER FEE: r?raB,r�U
<br /> CODE: SUBDIVISION: '���_ Lr,����g'� = -
<br /> T1JRN-ON FEE: • �"-�
<br /> °=': �'.--N�?45-:����, � , r- .:
<br /> PHONE: � OWNER OR TENANT: i� � � A ��}�� � � ��
<br /> BILLING/MAILIN `-,_.„ WATE� IMPA T FEE: �{-'f��-{;C.�
<br /> ADDRESS: �: ': . �U'`�l,,� ����'a ,` = ,i.-i ;; �,r ,
<br /> • t r_
<br /> } � ._,��t.1.
<br /> SEWER IMPACT FEE: i'��`�'` �`-�
<br /> CLOSING/SERVICE DATE•
<br /> �i'�t��P�
<br /> �CI� �P._ ���'b�5��_��f^
<br /> (STATE) I HAVE READ THE ABOVE AGREEMENT AND
<br /> (ZIP CODE) UNDER$T�iND THE CONTEN�-�h{E6�E6F--__�_._._
<br /> `�,
<br /> COUNTRY (TYPE OF BUSINESS BY� �� !� � � �' ���' '��f
<br /> � .. � (A��LT �Nl) , �
<br /> PASCO COUNTY UTILITY DIVISION, BY: � � � 9 ' �..,�`-
<br /> DATE: �} � l l --}
<br /> PC95115020/A
<br />
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