Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutProject Information � 2j2-,
... •... �.-. ti , .. o ._- .l ..r a..,h. w :.1-.�.. ... _x..r ..:..ev .., a:-..xr 'E: ..'': T'
e.r.rF''.ri.r.•.('z.Tµ.�-r,.a...k+-h.',.aamof"i':a'at_:aadw..'S..f..-.r,
;'tr�lr�-,.�,,.,,..au:.ti.�.h,, ,...:x.a..a. .l.,�.�-1.1,..•I,*L.e- IT
y)r.•x i..,..,ra..-..-.:r+,.;,:.:.-,.".,...�,,`'yr,r.y .._ T.t ;6'S•�!`, Gn't. �`�'HI t��4"L �" "�...W3y ` '7rX?
,f..,. �•, rr.
f ,?'!Ni't".�r•,:.!t'' oaSYft}t'ztrx.,s
{¢
c
WATER F.a:�B© .� IERC 34 $Z
ST.I U 1E'COUNTY UTILITIES
SEWER - RES �, f
NAME 'lf' �S "`";:' !'
=< METER SZ. . � �Iv/
ACCT.#
a IRR
4
_
JA
SECUlI3T Y IEP ` : SERVICE ADDRESS _"
SEWICVA—
E FEE
r,
SAME DAY FEE
B
C►VERTIME FEE. .
SUBDIVISION
LOT
BIrrOCK
BILLING DRESS
METER INSTALL ,
-CFGWATER
FPUA CFC '" .. °`
�P
Ht3NE# �.�
. .
MOVE DVICLOSING DATE
r , CFCISEWER _ f..
GUAR.REV.
This application.hereby request and authorizes the Utility to render water and/or Sewage disposal
services to the-premi'se's described above in'accordaace:with,the Utilities present or.`future rates, .ff
,...
LATERAL . rules and�xeglations� which by,referencia are.macie a°patt of";this contrast:Applicant agrces'to gay
. .. ,,.
lity,;` Mptly f the astabLsiied rules and-rguia to}" the L1t or such services`in°accordance:withr
/fix
----5�- . CUSTOMERS DEPOSITS ARE NON NEGOTIABLE QR TRANSFERABLE.' ' §`
CUSTOMERSOCIAL SEC
t`
a, SIGNATURE 1t fj]J7 I/ �
M ! ` 'v' M''rtiF'Y"
FED:ID D/
7
v
•e
a .Y
AME OF�SPOUSE 4. SPOUSE SOCIAL SEC.
N
FI
E USE QNLY
`DATE°RECEIVE I CASH �H
, '
.4tl
�� �, .�+ ' � a ., . ?_ . - .. - � r.•t � `:;1 i,�n� •"+ no-`{ t .i$ ,�" ,� '',qt