HomeMy WebLinkAboutSLC Receipt--y— WATER
SEWER
—WMETER SZ.
S
CUSTOMER
SIGNATURE
NAME OF SPOUSE
COMM
RES
— M/F
r� _� IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
V METER INSTALL.
GFGWATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
- - - - •, -�• _ ....0 - r.v, tiVX 728 Fx: P`I'E/RC!E�
NAME��ll�-� J-�
ACCT. # �L / -�- ' �I Lf
SERVICE ADDRESS
SUBDIVISION-� LOT
`BLOCK
BILLINGADDRESS�
�3 r-
PHONE # lj J ]MOVE 1NICL,OSING DATE
Phis 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,
ules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
he Utility promptly for such services in accordance with the established rules and regulations.
:USTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID �12— ?
SPOUSE SOCIAL SEC.
DATE RECEIVED 1 / vrIfME Mt ONLY
C� CASH CHK # cib
RECEIVED BY