HomeMy WebLinkAboutUtilities ReceiptWATER
SEWER
METIER SZ.
P F
RES ST:
RES NAh
M/F
IPR `
S 155I�(.J SHCIJRITYDEP
SERVICE FEE
SAME DAY FEE
OVERTIME,FEE
D+) METER INSTALL.
CFC/WATER
FPUA CFC
CFCISEWER
GUAR REV.
LATERAL
TOTAL
MOM2R g 00_ rAl il►
This application hereby request and authorises the Utility to tender water and/or sewage disposal
services to the premises described above in accordauco with the Utilities present or hture rates,
rules and regulations, which by reference are made a part of this contram Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.,
CUSTOMERS DEPOSM ARE NON NEGOTIABLE OR TRANSFERABLE'
-FS DID SEG ,s� - '3060114 y
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEI CASH CHK N RECEIVED BY
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