HomeMy WebLinkAboutCOUNTY UTILITIES FEES1,766 _CJ21-3;
WATER COMM
SEWER RES
METER SZ.' M/F
ACCT. #
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$ / W SECURITY DEP SERVICE ADDRESS
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SERVICE FEE u 1 ` 1
SAME DAY FEE SUBDIVISION / `0 LOT BLOCK
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OVERTIME FEE 3b 0�).VI-p!
. BILLING ADDRESS �
METER INSTALL. f
CFC/WATER ` vvi—
FPUA CFC PHONE # MOVE IN/CLOSING DATE
CFC/SEWER
GUAR. REV. 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,
LATERAL 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.
$ J % L ` TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE
NAME OF SPOUSE
DATE RECEIVED
A
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY �/�
CASH GH*9*- V r c_ . RECEIVED BY-A1 .
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