HomeMy WebLinkAboutSLC Utilities ReceiptLWATER
COMM
SEWER
RES
METER SZ.
MIF
G� IRR
Oa
$ /
SECURITY DEP
SERVICE FEE
YAME OF
SAME DAY FEE
OVERTIME FEE'
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
TOTAL
SERVICE ADDRESS F!DV If - a.`.D
aMw
;UBDIVISION �LOT 33 BLOCK
BILLING ADDRESS
PHON� # 0 77 t/ MOVE IN/CLOSING DATE
�9f� kzi44 � . aGOTlf i=��(Jlf
C AIAI Tics r1Y �� RgD�t�S
Tins application hereby request and aut orh izes�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 m accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON44EGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
71ATC DCI'1rT\/T+`Tl reru rT4w it 17RrRnran RV