HomeMy WebLinkAboutCOUNTY UTILITIES FEESWATER
SEWER
COMM
—T
RES
- METE SZ.
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALI
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR_ REV.
—;2
LATERAL
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
NAME _ Il.
ACCT. # tl 9
SERVICE ADDRESS ('T 5l 0
r
BILLING ADDRESS
( r
'C. q___
—LOT --- �BLOCKS
PHONE # MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
tiles and regulations, which by reference are made a part of this contract. Applicant agrees to pay
he Utility promptly for such services in accordance with the established rules and regulations.
�USTOMERS DEPOSITS ARF MOM ATRnnmi .
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
DATE RECEIVED F CE CASH USE ONLY
CHK # RECEIVED BY
E C [E 9 ., _E