HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER
RES
MEfERSZ.
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
l
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE
NAM
ACCT.
SERVICE ADDRESS (a 1 a / lw�
SUBDIVISION ��,, rr %✓� �pLOT BL%OCK�r
BILLING ADDRESS 2i6 ( SE IN ���� (rYr"l S ��� - J SL ' - /
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EMAILADDRESS: rs7/c�oG t/vG coal
PHONE # S�6 / !�;~0 ? Q (2 -? D MOVE IN/CLOSING DATE
This application hereby request and authorizes 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
Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/FED ID 5 74 6 '� 6 'J `
NAMEOFSPOUSE ! �i `C �IitI f� SPOUSE SOCIAL SEC. �Z-7 7 Z z
OFFICE USE ONLY DATE RECEIVED t o`� �� CASH CHK # 1 �6 I RECEIVED BYa—f*