HomeMy WebLinkAboutSLC Utility ReceiptWATER COMM
SEWER _ R.ES
METER SZ. M/F
00 IRR
6 SECURITY DEP
SERVICE FEE
SAME DAY FEE
l OVERTIME FEE
METERINSTALL'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
S c TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
SERVICE ADDRESS 10j'j Be2_/
U BLOCK `�
BILLING
PHO_ # —IUD b J J V MOVE /CL05IN4-4 DATE 7�
Th?s'applicatton hereby request and authorizes the Utility to render wafer and/or sewage disposal
se. -vices to the premises described above in accordance with the Utilities present or future rates,
roles 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.
SOCIALSFC/
FED ID
SPOUSE -SOCIAL
OFFICE US>E ONLY n
D_AZ RECEIVED'% `f/ c CASA CHK #i / RECEIVED B