HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
==(SEWER _�RES
'J—It--'/�-V/'�._iETER SZ. M/F
1 (� IRR
S- `� l �C� SECURITYDEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
II F� LATERAL
TOTAL
PHONE # Jk A� -
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,
mles 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.
'-USTOMBRS DEPOSITS ARE NON NEGOTIABLE ORTRANSFERA13LE,
CUSTOMER
SIONATURE �N Ckj�, hA
M&S
NAME OF SPOUSE
SOCIAL SEC/ ' ( — c_Jl�o
FED ID
SPOUSE SOCIAL.,.;,,,
OFFICE USE ONLY
DATE RECEIVED CASH CHK #
RECEIVED BY