HomeMy WebLinkAboutSLC Utilities ReceiptX WATER
SEWER
S TER SZ.
COMM
--LRES
M/F
1 y� IRR
` U SECURITY DEP
SERVICE FEE
— SAME DAY FEE
OVERThvM FEE
METER INSTALL.'
CFCWATER
FPUA, CFC
CFC/SEWER
GUAR. REV.
_ LATERAL,
O v (LTOTAL
SUBDMSION,C LOT_ 1 9 BLOCK c7 _—
PRONE #_ GI.V " .b 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 referende 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
SIGNA 1n SOCIAL SEC/
FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY ,
DATE RECEIVED CASH CHK # RECEIVED BY