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WATER COMM
SEWER —K— RES
METER SZ. M/F
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S O� e SECURITYDEP
.. " SERVICE FEE
SAME. DAY FEE
OVER= FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
$ rD O TOTAL
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CUSTOMER
SIGNATURE
OF SPOUSE
ACCT. ff. 45-5ya , SERVICE ADDRESS ��
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PHONE # �7���'''� MOVE IN/CLOSING DATE
This applicahon 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.
FED ID
SPOUSE SOCIAL SEC.
' / OFFICE USE ONLY
DATE RECEIVEDI'3! ' CASH CHK tlp RECEIVED B '1�
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