HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
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$ lJ C� SECURITYDEP
SERVICE FEE
SAME DAYFEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
(� LATERAL
TOTAL
CUSTOMER �I Q
SIGNATURE jk 0, V1
NAME OF SPOUSE
PHONE # f :!L�"I y' 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 n_a_v
the Utility promptly for such services in accordance with the established rules and regular'
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE, ,
SOCIAL SEC/ r-Jt�-�{^�/ � /
FED rD _ '--3 ! ^ t .p Lp y
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED EY