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SAME DAY FEE t1
SUBDIVISION.' CK7Ck' �(�-Q LOT !BLOCK CTi
OVERTIME FEE _ \
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BILLING ADDRESSy ��i%Y.
CFC/WATER /r/- J je/r e%� :• 3 /!/�/
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FPUA CFC PHONE.#_ -/ 7,.)-- M " /3.0 g MOVE;IN/CLOSING DATE
CFC/SEWER
This applic
GUAR.REV. ation hereby request and authori%es the Utility to render water and/or sewage disposal
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services to the premises described above in accordance with the Utilities present or future rates,.
LATERAL rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
qR the. Utility promptly for such services in,accordance with the established rules and regulations.
$ r TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE'ORTRANSFERABLE
CUSTOMER
SIGNATURE
NAME OF SPOUSE.
DATE .RECEIVED
NAME % A7 e-
ACCT. #.
SERVICE ADDRESS
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONL
CASH.. CHK # (�'3 RECEIVED