HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM
SEWER K RES
METER SZ. MIF
l� IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
O) METER INSTALL. -
CFCIWATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
CUSTOMER
CUSTOMER
SIGNATURE
NAME OF
BILLINGADDRESS
# ��/yyJ MOVE /CLOSING DATE
This application hereby request and au orth tzes�the Utility to render water and/or sewage disposal
services to the premises descnbed strove in accordance wish 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.
SOCIALSEC/
�-
FED ID
SPOUSE SOCIAL
f OFFICE USE ONLY — G
DATE RECEIVED CASH Cm # { RECEIVED