HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
_ SEWER _ RES
TER SZ. M/F
1 � MR
$ - s ,c my DEP
SERVICE FEE
SAME DAY FEE
OVER.MdE FEE
METER INSTALL. '
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
CD TOTAL
NAME _ (' �t��1/1S U Z G
ACCT. # — 1 �.~L 3-
SERVICE ADDRESS ! !
30'.r)
/ SUBDIVISION ��g---- LOT C;BLOCK `
PHONE # &A—D
IN/CLOSING DATE
This application hereby request and authorAes 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 par-.
the Utility promptly for such services in accordance with the established rules and regulation'
CUSTOMERS DEPOSITS ARE NON N13GOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
0MCE USE ONLY
DATE RECEIVED CASH CHK # RF!°Rrvcr, vv