HomeMy WebLinkAboutSLC Utilities Receiptl
WATER. Comm
1 SEWER RES
TER SZ. M/F
IRR
S l + t SECURrIYDEP
-_ SERVICE FEE
SAME DAY FEE
OVEItTiME FEE
METER INSTALL,.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
�QQ TOTAL
CUSTOMER
Ja
NAME f'rnS �2p
SERVICE ADDRESS
PHONE #__ IL4_3 MOVE IN/CLOSING DATE
This application hereby request and authoAcs; 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/ t
FED ID[
NAME OF SPOUSE SPOUSE SOCIAL SEC.
-OTFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY