HomeMy WebLinkAboutSLC Utilities ReceiptWATER
IesEwER
METER SZ.
RES
i IRR
S -- - -' SECURITX DEP
SERVICE FLE
SAME DAY FEE
OVERTLME FEE
• Q� METLR INSTALL.'.
t Qi� CFC/WATER
F'UA CFC
CFC/SEVER
0D GUAR REV.
p� LATERAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
NAME -V �) L— V
f ACCT #
SERVICEADDRESS G
' I
SUBDIVISION e �Q LOT
qq
PILLINGADDRESS �3
PS �
PHONB # MOVE INICLOSING DATE
this application hereby request and authorizes the Utility to render water andfor sewage dispos
-ervices to the premises descn'bed above in accordance with the Utiiities present or figure rate
Ides and regulations, which by reference are made a part of this contract. Applicant agrees to p2
he Utility promptly for such services in accordance with the established rules and regulation
,USTOMERS DEPOSITS ARE NON NEG6TIABLB OR TRANSMZ ABLE.
SOCIALSEC/ -
t FED .ID
SPOUSE SOCIAL SEC.
DATE RECEIVED 1 { I t OFi�TCU USE ONLY
_`i"_r `"" CASH CMC # q � S