HomeMy WebLinkAboutAPPROVED SLC COPY RECEIPTWATER COMM
SEWER � � RES
METER SZ. M/F
IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METERINSTALL.-
CFC/WATER
``�'l FPUA CFC
yU CFC/SEWER
GUAR REV.
LATERAL
S � D TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
NAME
�k-iE.cilr} C}�ar' r��,,c��tc�lUc^k crc IeYIJhlrf+��iJNpct/ arm
y 5z1 � i/1Stc.l�er�P�. �I�C�c�. �.���C-
This application hereby request and au horizes t e ttltty to ren er water ors age disposal
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations, which by reference aze 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 NONNEGOTIABLE OR TRANSFERABLE.
FED ID SEC/ �� � /,n , ` , / � ��
SPOUSE SOCIAL
UN'!''rl:E U�L�' V1VLY �
DATE RECEIVED � � � CASH �#�_ RECEIVED BY
WATER COMM
SEWER � RES
METER SZ. M/F
IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METERINSTALL.�
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
S TOTAL
CUSTOMER
SIGNATURE
NAME
SERVICE
��T G>v���-hon �sul�i� � L�[,
SUBDIVISION 4/r% %�%/� � /y���LOT��/JBLOCK
BILLINGADDRESS / /I!/Q � _�\� � ��
(. I�ep�q� O��a,(.�, /,f� �� �3 4� / /
PHONE # �`d-.,1C►/��/q����t/ MOVE IN/CI,�OSING DATE
Ejasr_ � I' �rtSta.lYeJri �/n aX� 0% A9k' (.1�+1�/t� ' ry
This application hereby request and autho to rea er water and/or sewage disposal
services to the premises described above in accordance with the Utllities 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 UR TRANSFERARi.F.
SOCIAL SEC/ r�y�Ty��, l/ ��
FED ID � lj (�T� �f fo
NAME OF SPOUSE
SPOUSE SOCIAL
VP NlI:r: U.IY: V1V LY
D TE RECEIVED CASH t?iiir#. RECEIVED BY