HomeMy WebLinkAboutSLC Utilities Receipt.� WATER COMM
EWER RES
S TER SZ. M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERMa FEE
METER INSTALL.'
- CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
ff II L"'IE Ar
TOTAL
8 �'020
NAME
SERVICEADDRESS -53C� �5
PHONE # MOVE IN/CLOSING DATE
This application hereby request and authio&es 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.
CUSTOh RiS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE,
CUSTOMER l �l Q hA
SIGNATURH _[1] /U. �A ,t
NAME OF SPOUSE
SOCIAL SEC/'
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK #__ RECEIVED BY