Office Use Only:
Acct#:  	
Date of Svc Acct: 	_
Application Approved Denied (Reason) 	

St. Lucie West Services District
Temporary Reconnection Application

The St. Lucie West Service District (“SLWSD”) will temporarily reconnect water service at a service location that has been shut off as provided herein for the purpose of home inspection. Application must be made at least one business day prior to temporary reconnection of water service. Temporary reconnection of water service may be scheduled between the hours of 9:00 a.m. until 3:00 p.m. on a regular business day of the SLWSD.

Complete the following information to temporarily reconnect water service. (PLEASE PRINT)

Date:  	

Property Address:  	

Property Owner Name:	Phone #: 	

Authorized Representative Name (if applicable):	Phone #: 	

Property Owner or Authorized Representative Address:  	 (If different than service address)

Property Owner or Authorized Representative E-Mail: 	

Requested date of turn on:	Requested time of turn on: 	, Time of turn off will be by 3:00pm.
Required documentation along with this application is:
Acknowledgement and Release of Liability form.
Copy of legal proof of ownership or other interest in or to the property (If authorized representative, also provide proof of legal representation);
Copy of personal identification (ID);
Payment of $25.00 temporary reconnection fee (non-refundable); and

The SLWSD strongly recommends someone be present at the time our technicians arrive to temporarily turn on water service. When water service is turned on, there is a chance that a hose, toilet, sink, shower, etc. could be turned on and/or leaking and possibly could cause damage to the property. If at the time of turn on, the meter is found spinning, that is an indication that water is turned on somewhere within the property. If the meter is found spinning, the technician will shut the meter back off. The applicant will need to provide a new application for temporary reconnection in order to schedule another temporary reconnection. The SLWSD is not responsible for any damage caused to a property from the temporary reconnection of water service.

To turn on service to the location, a consumer must make proper application for service with the SLWSD. Any outstanding balance on the service account at the property location must be paid in full to turn on service.

The undersigned does hereby request to have the water service temporarily reconnected at the above service address under the terms and conditions listed above.

(Signature of Property Owner or Authorized Representative)	(Date)

Updated September 11, 2013

450 S.W. Utility Drive  Port St. Lucie, Florida 34986  Phone (772) 340-0220  Fax: (772) 871-5771