HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER _ RES
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SERVICE FEE
SAME DAY FEE
OVERTIME FEE
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CFC/WATER
FPUA CFC
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NAME (-AVLWIVgS
ACCT. # Ll �A —
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SERVICE ADDRESS
SUBDMSION`�—�(L� LOT BLOCK.
PHONE # �W —' �`� MOVE IN/CLOSING DATE
This application hereby request and authoriles 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 NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER n SOCIAL SEC/
SIGNATURE li/�Y FED ID _ �Q
NAME OF SPOUSE SPOUSE SOCIAL SEC.
'OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY