HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER RES
J ETER SZ. M/F
r IRR
a ' f
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METERINSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
'I ^� LATERAL
. A `+" J TOTAL
�ISTOMER
SIGNATURE ( I A
NAME
ACCT. #
SERVICE ADDR13SS
- ,3,99
J'1
MONE #--L < — b � MOVE IN/CLOSING DATE
This application hereby request and author zes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
vies and regulations, which by reference are made a part of this contract. Applicant agrees to pay
he Utility promptly for such services in accordance with the established rules and regulations.
�USTOMERS DEPOSITS ARE NON NEGOTIABLE ORTRANSFERABLE.
buulAL SEC/ 'Z� 7
FED IDE�q 1
-T-�
NAME OF SPOUSE SPOUSE SOCIAL SEC. `
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY