HomeMy WebLinkAboutSLC UItilities ReceiptWATER Comm
iSEWER �^ RES
TER SZ. _ M/F
1 ,t''�1( (� y� IRR
l `—C . 60 SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERMIE FEE
METERINSTALL.
_. CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
TOTAL
CUSTOMER �1"A
SIGNATURE�U`�
NAME OF SPOUSE
NAME
ACCE #
SERVICE ADDRESS
57
PHONE #- IVb 2 M I MOVE IN/CLOSING DATE
This application hereby request and authorles the Utility to reader 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
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY