HomeMy WebLinkAboutSLC UTILITIES RECEIPTX
WATER
COMM
_SEWER
(�
RES
METER Si.
M/F
IRR
$
SECURITY DEP
00)
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
t,
CFC/WATER
r
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE ` C,(/jY 1 Ci
a bg
DATE RECEIVED
RECEIVED MAR 2 9 =
NAME
ACCT. #
SERVICE ADDRESS
SUBDIVISION fktwObid-J-t// ,LOOT y t BLOCK
-/ BILLINGADDRESS / l�I.Y T J
09%Y0'
Ct•IONE # O CQ 1 �g 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,
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.
FED DL SEC/ U' 3 / 3 K \
,O SPOUSE SOCIAL SEC.
OFFICE USE ONLY
CHK# RECEIVED