HomeMy WebLinkAboutSLC Utilities ReceiptA WATER
SEWER
/ f i METER SZ.
COMM
x RES
M/F
_ IRR
Y. �i ....� SECURITY DEP
SERVICE FEE
SAME DAY FEE
—�-- OVERTIME FEE
I - METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV
i ( LATERAL
� $ -/P C TOTAL
NAME
ACCT. # A 55-i
SERVICE ADDRESS 541
,o^
PHONE # V A-5 - X,3! �_/ MOVE IN/CLOSING DATE
V
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 for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/
FED ID q — 36
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY