HomeMy WebLinkAboutUtilities.ra19_.
SEWER
11 1, METER SZ.
CO
Y RES
_M/F
IRR
$ Y� -r �9 0� SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFGWATER
FPUA CFC
CFC/SEWER
GUAR. REV.
7 LATERAL
TOTAL
CUSTOMER
SERVICE ADDRESS
BLOCK
PHONE # `�lJ i > j �I 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 inaccordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
11 SOCIAL SEC/ rn,
_ .FED ID ./ — 3a'ol
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED ,�*J CASH CHK # �� RECEIVEpBY / ?��