HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER _K RES
METER SZ. M/F
9 Da IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
0 METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
` TOTAL
- P.O.
SERVICE
SUBDIVISION LOT_BLOCK,,5
BILLING ADDRESS
'� 50
a-z-z' l s
HONE # "/UJ " b . 5/ MOVE /CLOSING DATE
CoAJNAgeT E LL Hr ✓e p `CAS
This application hereby request and aut orizes 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/ !^ ^ 3U(�d� FED ID "/'
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY