HomeMy WebLinkAboutUtility Company Approval�WA7ER
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SEWER RES
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M/F
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IRR
SECURITYDEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER.
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE
OF SPOUSE
NAME
lJ I ACCT. # n
SERVICE ADDRESS
SUBDIVISION LOT BLOCK
IN/CLOSING DATE
This application hereby request and authorises. the Utility to render water and/or sewage disposal
services to the premises described above in accordance with 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.
SOCIAL SEC/ II
FED ID � — s b(p o)
SPOUSE SOCIAL SEC.
-- C-�` 2l� _ OFFICE USE ONLY---