HomeMy WebLinkAboutSLC Utilities ReceiptATER
SEWER
RES
METER SZ.
M/F
IRR
(/ 00
SECURITY DEP
$ / .�' •
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
.� . L) n METER INSTALL.
nc) CFC/WATER
D FPUA CFC
r),C(1 lD Q Cf i' ! ER
if 5
G7
CUSTOMER
SIGNATURE
NAME OF
ST. LUCIE
NAME jYi0_r D[*)C 1C( C,
ACCT. #
SERVICE ADDRESS
SUBDIVISION U.A)e S kn e__, LOT BLOCK
BILLINGADDRESS 47600 Sul7z-
PHONE #!� �1I '7�AJ'5IV`[ 5 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 3
FED IDy
SPOUSE SOCIAL SEC.
DATE REC4 EDU a'� v 4 CASH OFFICE USECHK #YO ��O d (J RECEIVED BY•