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.. ,_�yy, <br />/ Tap No..._.:'�.'-/v (ti'....---.... <br />� MUI:{LTEO WATER DISTRICT G� = 9 <br />SNOH7MISM COUNiI', WASMNGTON <br />5�� <br />APPLlCATION FOR \M�TER <br />All blanLs must bc fillcd in or crosscd out <br />ALJ:iltcq 11'nsLincton, __ .....__�-_�.._7_. ......_ ..., 19�5 <br />TO Tliti SL'I'f.liI\TE'�DL'ST OP TIIC I.ili3CILTGO 11'ATER DISTRiCT: <br />I hcrcLp apply (or thc usc of �ratcr in acmrdancc ���ich thc rulcs and regulations <br />of tLc Mukihcu �\'aicr District. <br />DurinG thc time t6at am� of the wa�er mains mac be taken up br rcason of <br />any improvcmcnt authurized Lc ihc District in or ot �any strrct, raad or allec in <br />which thcp map have Lccn laid, ihc District wifl not Lc rcquircd to furnish watcr <br />during tLe progress of sucL impro��emenL� �o am• eousumer whose suppip may thus <br />Uc cut o(f, or Uc liablc for anr damagc (or iu tailure su to da. <br />Appliration \u._..._..... <br />Illock ...____. <br />Ko. . <br />I.ot .__.._ � _..___.__. Add.RiC�ia.c.t�,p.Ci..!K...4(� <br />Strrct_ ............. <br />_- �...._..'.. __,.._ �SOS C:i.�.E...GIc�.:-•xCs�-.�rc.cc.�..........._. <br />„ ', <br />`l-i � � <br />. . ._.._�....... .........._. .._..... . <br />.. ....._... ............. ..._............ ...._........_.. <br />Statc size of top: ._._-�?�___..... inch. <br />Cj 00 <br />$../�n--.—.-.---.. .........Las bccn rccciccd with thi! application. <br />. ..____..._ _ .. . ............. ......._.. ..... ....._._._. ._..._....... <br />�� Supc»nlcndrnf. <br />Tlre prcmucs nrc to bc uscd as a`✓'� r ��L.� .___.._ .__........_. <br />TLc owncr of thc prcmisr, is.'-�!i-c.......�i+rc�r+.a....•_� .__ .............. ._.._..__. <br />1'Lc agcnt is. _.._.. ..� .. <br />._..._ .._.._..._.. ...._ ... ..........._ .._ _._.._._....._... <br />This npplicauon �It6ouch i¢ncd, sh�ll uot 6c bmdmr upon ilic Distrir.t until <br />arccp!� d b}� tLc Supcnntcn� oC thc \,�l�d ijhio i1'atcr D�strict. /�/ <br />Sgmd../L .._._'.-'/'!!�'�??ti..i.:t' ....__....Owncr. <br />� ' <br />Bp_ ..............._..._.........._........_..__..............__.._............__...._...............__. _.......___....:lgtnl. <br />:\c,cptcd . _.... . . l� ... By . _... <br />. .. ._ _. _ . ._ ......... ....... <br />Snyerinttndcn;, <br />