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-T LIKIE �UNT�Y UVATER & EWER DISTRICT �SLCU�
NSW CUS 'C3ME}i kPPLICATION
WAXER` COMM
E RES -NAME s
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ACCT # 13 T/ i
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SECURITY l�Et� ER
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SERVICE
SAME DAY FEE ;.
S:UBDIVLSLO,NY _ LOT' ;BCO
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O\!ERTIIW E FEE j�
BILLING Ipb,.ftESS � Cf _fy6 CFC�IAlATER EMA1! AaDRESS'
FPU 'tvFC PHONE#' � `'I. �. ` `:iViOVElN�OSIN.G DATE.
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CFC SEVti%ER`.
This a It cation Mereby re nests and�aut' zes the Utrii ,to renderwater andl„o sewage disposal
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gseryFces.,ti the.ptemsses desc6edboVe rn,accordant e with the,lJttliies;,reseni or: tcrre rates,r�i1'es.anc>
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? - :i`egWat�ons,�n+ ieh by reference are made a;part:of` his contrac[.APpltcart agrees to Pay Uttl,ty.promptlyfor
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such services i�accordance.nnth thertstabltshed riEeand"regulations..
CUS QMERS OPPO5,ITS ARE NWNEGOTIA8LEO) TRANSFERASLE,
APPLTCAIT A G`REES,TEAT APPY.YC`ANT G4'�LI, BEGIN PAYIl�TG BASE EACH�fiY C>BEAItGES JE`bR 'J[`BE3TH .'TY �' �CCE
APl'LI)�ll T'OR U1rT THE DAB 'THE VA'TER METER :OR, III[ Y ER' CE kCE}1!A�]ECTIQN,IS TSTALLED A
- rAPP�IGANT';SP_ rP�TY,REG.A'RULESS 0� �1•A�'CSC:A1YT:aSTA.RTS.�V:T�:�°:��E.1VlETER::i�.l�l'D,/„+LIR,SER�ICE,
iJTCIv±IER 51ATU1?E � S_O,CiALECjFEf�,IA'
?NAMEOk k USES _ SP..OUSE.SO:CIAL
. ._ C}FFIiGE USE LY }
DA7Ez.lECEIUEC►.. .. . CASH. CIECIC# �11 :RECENEI?&Y .`
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