HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER _ RES
METER SZ. M
6 g QE� MR �
SBCURr1 Y DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
IMETERINSTALL.'
CFC/WATER
FPUA CFC
CFC/SntER
GUAR REV.
LATERAL
TOTAL,
SIGNATURE
NAME OF SPOUSE
NAME
ACCT. #
SERVICE ADDRESS
j.
T"f% `
046 -A
m0 % 2
LIT S - P.O. BOX 728 . P]ERr r lm 34982
_l .P y
BIILBITOADDRESS (kItc1
PHONE # ` `l(� ^ b � MOVE /CLOSING DATE
�&A
U�urr�ioiu-r /32� t;� .� 4applacation hereby request and Gut orizes'the Utility to render wafer and/or sewage disposal
S vic -S to the ptemises described above in accordance with the Utilities .present or fiihire rates,
rules and regulations, which by reference are made a. part of this contract Applicant agrees"to.pay
the Utility promptly far such services in accordance with fhe established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SBC.
OFFICE USE OBIT lr �,