HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER RES
S`/
(� METER SZ. x M/F
S', DO BY
SECURITY DEP
SERVICE FEE
SAME DAY FEE
!l OVERTIME FEE
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CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
ACCT. # I J t> / r: 10 117 2
SERVICE
PHONE #
_LOT_] L/_BLOCK 47
_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 QRTRANSFERABLE.
SOC�AL SEC/
ED IDJ�� ���� � v
SPOUSE SOCIAL SEC.
OFFICE USE ONLY 1 , f
DATE RECEIVED , E o CASH CHK # ��Jt 37�'� ,3j RECEIVED BV�W'-' ``