HomeMy WebLinkAboutSLC UtilitiesWATER - COwG.J
SEWER_ RES
METER SZ. M/F
$
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL. -,
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
TOTAL
CUSTOMER
ACCT. ff
SERVICE
This application hereby request and authorizesthe Utility to render water and/or sewage disposal
services to the premises described above is accordance with the Utilities present or futurerates,
rules and regulations, which byreference are made a part of this contract. Applicant agrees to pay
the Utility promptly for suchservices in accordance with the established roles and.. regulations.
CUSTOMERSDEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID
NAME' OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY i�'
DATE RECEIVED -JQ- CASH CHK #�05"i/ RECEIVED BY�,p-! )d '