HomeMy WebLinkAboutSLC Utilities Receipt_,
WATER COMM
p SEWER RES
OMETERSZ. M/F
IRR
�� • ND SECURITY
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
CFC/SEWER
GUAR. REV.
LATERAL
$ �C=TOTAL
SUBDIVISION _ LOT i)
BLOCK
PHONE
IN/CLOSING DATE
This application hereby request and authodics 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 for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NONNEGOTIABLE ORTRANSFEPA13LECUSTOMER j�
SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/
FED ID_
SPOUSE SOCIAL
OFFICE USE ONLY