HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER __Je!�'RES
METER SZ. MIF
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
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CFC/WATER
l 6- Co
S
FPUA CFC
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CFC/SEWER
GUAR REV.
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$ 76 (O • d 6, T9TAL
CUSTOMER
SIGNATURE
NAME OF
ST! IE COUNTYJ UTILITIES - P.O. BOX 72288, FT PIERCE, F' 32
NAME Iva -
ACCT. #
SERVICE ADDRESS
SUBDIVISION g/8,- X' 5%Vlle LOT�BLOCK (�_
BILLINGAD;;D��RESS �J(o/D /�%S�'U�� S� • N
i
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.
SOCIAL SEC/ C /
FED ID u ✓ (Z-
SPOUSE SOCIAL SEC.
[ OFFICE USE ONLY {� `
DATE RECEI D D &/ CASH CHK # a / RECEIVED BY y,