HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER' RES
ETER SZ. M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
(� LATERAL
— ' + TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
NAME _ j'VLQLVYLS
SERVICE ADDRESS
A ' ri _
SUBDIVISION`S LWt2 �� LOT
BLOCK_ :..�
PHONE #— lux—) — b � j �JMOVE 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 fer such services in accordance with the established rules and regulati,,
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ '
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY