HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER RES
METER SZ. M/F
00 iRR
5 SBCUR= DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
On METER INSTALL.'
CFC(WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
TOTAL
CUSTOMER I (�
SIGNATURE V ,
SERVICE ADDRESS `? / .� . JAL/ 41 U
SUBDIVISION_ �����LOT.BLOCK
BILLING ADDRESS ¢
MOVE /CLOSING DATE
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Con��v �•' au�' Imo' .T�cs� +� ram' A���s
Thus application hereby request and an oth rizesththe Utility to render water and/or sewage disposal
services to the premises described above in.accordance with the Utilities present or furore 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/
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FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY
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