HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER_ RES
METER SZ. M/F
IRR
$ 11
4 1 i_ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE
NAME�-
�y 1
ACCT. # J f� --
SERVICE ADDRESS �JC� v , �
.-kaj d-111?'Irr V -""o C/ C? / -. 7
SUBDIVISION�� ' LOT D BLOCK
BILLING—,ADDRESS�� lql f l -f' 1)hJ4 tLl
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W
PHONE —".Y-3��,
MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
'USTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ ri r
FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
r
OFFICE USE ONLY
DATE RECEIVEd412.10 CASH CHK k4L?_-Zy RECEIVED BY