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, APPLICATION FOR SERVICE
<br /> PASCO COUNTY UTILITY SERVICES (727) 847-8131 NEW PORT•RICHEY
<br /> 7536 STATE STREET, SUITE 118 (813) 235-6012 LAND O'LAKES
<br /> P.O. BOX 2139 (352) 521-4285 DADE CITY
<br /> NEW PORT RICHEY, FL 34656 ���"�' �- aj'.`��';�'g:;
<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 WRITTEN NOTICE HAS BEEN RECEIVED
<br /> BY PASCO COUNTY UTILITY SERVICES 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 HAD 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: f j� , ax' ��
<br /> )- �°t�` �
<br /> ACCOUNTNO.: z�',' � ->--°oa'2 �.---c?-�k=�.
<br /> DEPQ$IT D`A�TE '�' '����" 4���,'�
<br /> NAME: ` '� '::,$ t'*;a i4�'.Y. s=°_,.ti'�f^�.r��AS�1 ' �'�� � c 1��u j r:d r`�"�t.��r;� t� .
<br /> DEPOSIT FEE: t��'�x
<br /> (LAST) (FIRST) (INITIAL)
<br /> SERVICE
<br /> ADDRESS: : � �:s::: �;�-���;�'n ��_i i�=� �_r° I,``:�-�� ,...� ,.,'';,
<br /> ��t°���.� �� � METER FEE: -`:�m� � '`':%
<br /> SUBDIVISION - �
<br /> CODE: `''x`� ���k:? ''.#�:_�'t�t��:;�
<br /> SUBDIVISION: TkRN-ON,FEE: 4 �4�
<br /> PHONE: ,��'r: �r fi °,<<:� :�#� �:"; �''��� �,�Lt''-� �:� ,�.��a
<br /> OWNER OR TENANT: a V1/,qT� IMPxACT FEE: g "°�` ���:e
<br /> BILLING/MAILING� ;,r. � a — -
<br /> ADDRESS: 8;r� : s"�t , }•,4 §1��` �� .��,�t'�;� � �� i:x�.�
<br /> S�W�R IMPACT FEE: y 'z�� ��s'�
<br /> CLOSING/SERVICE DATE: ?�' � �
<br /> �';��,;��'�a 3=,� _F-� ,...,_ —
<br /> " `�''';��f::�^�'� I HAVE READ THE ABOVE AGREEMENT AND
<br /> (CITY) (STATE) (ZIP CODE) UNDERSTAND THE CONTENTS THEREOF:
<br /> ,�8; � ,� ,
<br /> (COUNTRY) (TYPE OF BUSINESS) BY� '���x -;' Y �C.'"°-��,6'`'��'`° Y,
<br /> �; ,, '
<br /> (APPLICANT)
<br /> PASCO COUNTY UTILITY DIVISION, BY:_ .� ��� � � � �
<br /> ' }�(: .�,� ,{rF�— DATE: ; � s� .�,� f�_�.
<br /> _ , F
<br /> PC95115020/A J
<br /> _ . .
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