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HomeMy WebLinkAboutSLC Utilities Receipt�y _ SEWER r[&MUR SZ_ COMM ST. LU RES NAME M/F IRR SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE METER INSTALL.' a:. CFC/WATER FPUA CFC CFC/SEWER GUAR REV. LATERAL S ©� TOTAL CUSTOMER SIGNATURE NAME OF SPOUSE ACCT. # SERVICE ADDRESS S FT. SUBDIVISIONV!� LOT BLOCK PHONE # _ JU-D — -�) `1 y' 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 NEGOTLABLE OR TRANSFERABLE. SOCIAL SEC/ � FED ID .- . (o 1 SPOUSE SOCIAL SEC. DATE RECEIVED T - 2� CASH OFFICE USEONLY # RECEIVED BY _