HomeMy WebLinkAboutSLC Utilities Receipt_ WATER COMM
U SEWER RES
O METER SZ. h,I/F
IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
INAME
ACCT. #
SERVICI
SUBDMSION__�� LOT �t 1 BLOCK 1
B
PHONE # / MOVE 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 for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SEC/
SIGNATURE FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY