HomeMy WebLinkAboutSLC Utilities Receipt_ WATER COMM
SEWER_ RES
METER SZ. M/F
IRR
$ -- SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
l QCD TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
NAME 1{ tUVY
ACCT. #
� - 6' M
SERVICE ADDRESS J fj�•
�r
1 �
BLOCK
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/ r
FED ID
SPOUSE SOCIAI; SEC.
DATE RECEIVED CASH OFFICE USE ONLYCHK #
RECEIVED BY