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WATER
COMM
SEWER
RES
METER:SZ.
M/F
IRR
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
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LA �-1 —�
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
r
TOTAL
CUSTOMUREER
SIGNAT
NAME OF SPOUSE,
ACCT. # ! 70 l0S—— �l l' Q
SERVICEADDRESS ��L4 7"�Y(r_.lCfl�f'l1
SUBDIVISION RE LOT BLOCK
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19C; L. `FI - tLm 3
PHONE # % MOVE IN/CLOSING DATE
i
This application hereby request and authorises the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future _rates,
roles and regulations, which by reference are made apart of this contract. Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID
SPOUSE SOCIAL
OFFICE USE ON
DATE RECEIVED ��/ CASH CHK ip RECEIVED BY�