HomeMy WebLinkAboutSLC Utilities ReceiptG
i
J
WATER
COMM
SEWER ! .
RES
ilfL(r
F
U
METER
v b&F
Oa
—' IRR
ECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
' On METER
INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
/
TOTAL
r" 70MER
cATURE
NAME OF SPOUSE
SERVICE ADDRESS i f
SUBDIVISION-64 U4 III✓ LOT 30 BLOCK
__j
BILLINGADDRESS
HONE # LIS 0 �% MOVE /CLOSING DATE
FIVE fircuu�y pd�' ��yyET&� ratio
CoNfU�DN-r g f49' FI toy A�4�S
This application hereby request and out onlizee 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/ -
FED ID !'
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY