HomeMy WebLinkAboutUtility ReceiptDocuSign Envelope ID: FD85FA33-2113-435F-A650-539F044B4B25
WATER
SEWER
METER SZ.
M/F
i� IRR
ffi �iJ.S� SECURITY➢EP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
1.� -1•�V METERINSTALL.
CFC/WATER
FPUA CFC
3 c7 c7 cFGSEWER
a p2o _ GUAILIF",
CUSTOMER
SIGNATURE
NAME OF
SGTAL
SE RVICEADDREASS � l 4\ 11 �.M 1 n PX
SUBDMSION W�`-ie-rcS�^e LOT��ELOCK_�
LL EINGADDRESS•Y3(OD/ (3/✓d .
03
PHONE # f5� 11) 3 6 qw 331S' MOVE IN/CLOSING DATE
This applicatim howby request and authorizes the Utility to render water and/or sewage disposal
servI
ces 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'UtRity promptly for such services In accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NBGOTIA13LE ORTRANSFERAELE,
SOCIAL SEC/
FED ED
SPOUSE SOCIAL
DATERECE1vED casx cHK