HomeMy WebLinkAboutSLC Utilities Receipt,/ _ COMM
SEWER � RES
METER SZ. M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
'S — METER INSTALL.
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Od n s FPUA CFC
�y,NCFC/SEWER
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GUAR REV.
I I LATERAL
O 0 TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
SERVICE ADDRESS _ 6 ��j' L�,L� O c /•.
SUBDMSION�XUA�IYIS�U�7�.` LOT -a BLOCK__
PHONE #9QG " 7J S_I y MOVE IN/CLOSING DATE
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,
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.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ ��] ^
FED ID _ [ (p�
SPOUSE SOCIAL
�^ OFFICE USE ONLY
DATE RECEIVED ' 'ICJ CASH CHK # ZUa62 RECEIVED