HomeMy WebLinkAboutSLC Utilities ReceiptX WATER
SEWER
TER SZ.
GQMM
_ RES
M/F
+� y� IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
L/ n OVERTIME FEE
METERINSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
TOTAL
SERVICE ADDRESS
5�s
PHONE #- I.V. — "� MOVE IN/CLOSING DATE
This application hereby request and author zes 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 apart 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.
SIGNATtJ E `, L �� YVt.�1 � SOCIAL SEC/ �Jq
`` FED ID _ ""
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY - -