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WATER COMM
p SEWER_ RES
® METER SZ. M/F
IRR
SHCURITYTY
$ DEP
SERVICE FEE
SAME DAY FEE
O VERTDAE FEE
METER INSTALL.
CFC/WATER
FPUA CFC PHONE
CFC/SEWER
GUAR REV.
LATERAL
$ TOTAL
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
the Utility promptly far such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE (AA8, ik-Ao , it, Wl
NAME OF SPOUSE
SOCIAL SEC/
FED ID Sri —] � t•10)
SPOUSE SOCIAL SEC.
OFFICE USE ONLY