HomeMy WebLinkAboutSLC Utilities - Water receipt1� WAT r+ COMM
SEWER _ rx RES
METER SZ. M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SE WER
GUAR. REV.
LATERAL,
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
NAME 1 ' }{ I [ • j �,. y 18 �.
f a
ACCT. # 1 + Sc I
SERVICE ADDRESS LfC�
t_.
SUBDMSION I LOT�BLOCK
BILLING DRESS _3900 au I r `U '�-)kwv
77 ,.._
PHONE #�"
--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
:he Utility Promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIA73LE OR TRANSFERABLE,
SOCIAL SEC/.}
FED ID
SPOUSE SOCIAL
OFFICE USE ONLY ..I /
DATE RECEIVED G�A�SH CHK RECEIVED