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. MUI:ILTGO �\'ATI;R DISTRICT <br />APPLICATION �Oi: ��'AT'6R <br />Meter Size: Service Addrcss: <br />Numbcr oi Units: I <br />!vieter will b; used for lchecL all that applyj: � <br />Dom=stic <br />Irrigation <br />' � �1 C� <br />Acct. No.: �� <br />Fire Service Fire Line <br />1 hereby nppl�� (or «•aie: service and acrce tn be go��ern:d. iu a:curdmice ��'ith the resolutions, rules and regulations of the n1Uf:ILTGO �1'ATf R <br />DIS'PRICf I�111'DI penaining io wuter service. nmc or herca(�er in clicet. Th: unde:sigu:d as o�sner u; r:pretientati��e of the he:ein-described <br />premis�c hcreb�� aprccz as. follu�es: <br />f I 1 'fhc consumcr ag¢cs 1n mstulL operrtc and muintain at ull umcs, lireir piumhin_ systcm m cnmplianw with th: curtent cJrtian of Ihc Um(orm Plumbmg <br />CoJe ;u it pertains in ILe preventi:m of coN:uninaGon. snJ proicamn Gom Ih:nnal ezpanvon duc to a duseJ syslem lhal caWd uccur �cilh tiie prcsem u! <br />fiimrc installalir.n of bamF.Omt' preecnters on the eoncume:'s sen�ire nnd�or ni pWmhwg fixmres. <br />Ri The consumer n@recs in insiall all bnchtlo�c prevenuon i¢sembiics requ:sicd by ihe A7N'U.:md tn maintain those back0o�a prcrenuon ussemblie; in �ond <br />wo�l:m� orJer. "I�hc tutcmhlicc shal! be oL•i q•p:. siu :md make approved hr the 1.1q'D and the lNasLim_ton State Ucpantncnt of lir.Jth Authonl� Tnc <br />:�semblics shall h; installed iu a=cnrJance wilh all standads eslablisLed hy tlu h1N'D. <br />(3) 'I�hc �cain me�cr �eill uo: be msuJkd uniil n�catcr usc mrvc�� has 6cen :;uhmiUed h�� Ihc upplic.�nt ;uid the Distriets Cmss Conne:uon Contml Spena!ist iius <br />dciermincd i(Ihe as�omer will necd ta insi:dl :i b;¢AOu�c prccenter nn the :us�amer's siJc of the meter. <br />(a i Th:n Ihc cosi o( :vi� ccicntiiun uf Ihr wTer scrvicc. rcunral. replacem:nt or repav �o rrnch:md ti:rvc thc prop.rt�� Jes:ribed shall be Forne by m�s:l( or <br />assipns:e. mencrls� of ihc premncs. <br />U I 7�hat all pipes. wa�cr mca��unr: Jeviccs :mJ oWer cunnectiou eqmpment up;trcam tiom Ihe meter shall. aher Iheir instaliauon. be nnd bacrnne th: prnpem of <br />Ihe �11Cf). mb�cn to:il! us regulaUnns pcnaining u� ��atcr srn�icc. <br />iGl Thal aficr mtiutllauun. d mcicr ur mcicr bus :wd appunemmccs :uc hurmd ur danmecd. lhe oW'n=r. ��ill bc hcld taponsible and :hu^_cd tix same <br />i? I Tha� �hc MN'U. �u uf(icctc and uga��. shall have Ihc rieht nf ineress onC c_�css to en upnn the prcmises �md pwp=rt}� dcscri6ed hercm (or Ilm purpus: n( <br />inspeniun. canuccting n; disconne:um� Ihc sen�ice nr firt such othci purPose: a, ihr scrvice may re<piim. It is also unJerstood during the lime that sm oi <br />Ihc u:ucr m;�ins mne bc out nf scrvicc hy rcnson of am� cmcrecncy or miprnccmcnts aulho;i[cd by th: �711'U. in mip sircct nr othcr locaUun in ��hich Iiic� <br />mac h;rvc 6ccn IaiJ. Ih; MP'U ��ill nnl be rcquiretl Io fumish ��:ncr durinc tlu nrneress nf such impruvcmcnts lo um consumcr w�hosc supph ma}� dms b: <br />nit olT. nr bc hable Ibr :inr dama!_cs fur ns fi�ilurc to du xo. <br />(EI 'fhal lhc M\I'D sh;dl 6avc ihc right �o chunec tl�e ra�es at :iny �imc b� 1<noluiion. v� Icmporarilg diswntmue the scrvse lo consunrers, yid lu inslall tlm <br />metcr(sl Io re�_isicr 0�: ���atcr consumcd. Tlie �1N'D sh;dl nnt bc hclu lia:�le (nr dam;iec 6c u'aler or olher cause «sulting fmm de(ccuve plumbine nr <br />:���i��,«� n,s��u�d n� are �,��„�� „< <,�<<��;��� �„ m.• �«���s.s s���i��s ��,u, ���,��r.:��,a m: r�.� m,r a!�cnLt uf thc M1VD muv h�rvc rospcGcd thc plumbm_' <br />:II1lI J(�PIIIIIICL'S SI1�II IIOI I1C j1ll'J(I fS J I18515 �0: Il'CO\'L'f�' Ifl C1til OI� �tl➢:ILC :G :1�11f1'S:IIII I� IIIC SII�I�II)' O� N'ffiL'I $IIJII �JII U! bl' IIi1�ROrIL'II h1' Il':15(1�1 0� <br />:¢;iJenL Imc pressurc nr other r.mse �vhatsnevcr. Ihe �1WD shall not Fc held liuhle (ur d,miages nur shall such failure o: intertuption (nr am� tcasunahlc umc <br />h: h:IJ to consiitutc a hreach n( convact nn thc pan af lhc �!11'U or in ;m�� �cay rciicvc �hc cansunicc, whcthc: tcn;mt or oH�ncr. fiom pcdorming !h: <br />o61i¢auuu nf sudi ten:mCs nr mener's conira:l 1Eaicr xhall b: uscJ b)� :ipph;am onlp on Ihe prcmisc:� describ_d herein. A ne�c application shall 6c liled <br />�. shnulA ��a�cn c� Jc+ucJ fm ulh:r prcmiscs allhou@h IocmcJ nu I:mJ Jci:ribcL herin. <br />:�(91 '. "I�h:ii Ihe 111\'11 recummcnds inslallalinn uf �i presxure rc��il:nin;; �:�he. :\pplicanl acknneleJRes infunnalinn :�s m Ihe rccummenJalion :md <br />'•.___� :�ssumes full respnnsibilin� Inr iust:dlin;; ur failiu;; tn insmll :i prexsurc re.'ulutiu� cake on lLr ���nter syslem �o prmect it Gnm lii�h <br />ine i-.�`� pressurc ' •�I\'f. <br />� QIII �.'I'he �t11'U ulilizes ebrcl; calrrs ;rt Ihr melrr tu prevenl ���aler rrturnin;; �u ILe UislriUs mains. 'P6r Dt1�'D rrecmmenJs installalion nf a Iherm:�l <br />�--� iapausinn tanluu prrcrnt ccccssicr prcssurr bui1J-up canscd b� tl�r ��atrn c�a�cr. Appiicanl ac(:nn��'Icd�cc in(urn�alion as ln Ihc rccummaW:diuu <br />and assumeti GJI respon^ibilih Inr ins'l:�lliu� or (ailing lo inslall a thrrmal czV:���+inn tank.�� �' I 11"I'. <br />r '� <br />SGI�\'ICL':1DDRGSS. ,/ �'_�.Q� � I.OTNG.� [3LOCI:'. __ <br />i;ITl75T.4TG'7.11'. - � -- PL:\7'I:AAfE� _ _ <br />011'NGR'SN:1�fE :- � - - .. � L'cG: .DI:SCRIPTIO\� �JL-- �� �'�' � <br />OIVNER'tiAl)DKL'SS �_ G <br />crrti:�srn'reric <br />7'uc prcnuscs nrc Io be uccd av a <br />Sf_I_\'I('I'7'1'PG� . <br />D_cdnper Insiallcd. ,�� <br />Uistn:t Insiallcd�. __ <br />D'I -t Install • Fulurc� <br />_ � _'L���t-5 � �-��'�-s t `� -J <br />6LDG I': ILM1 IT ISSUGD E31': - — - <br />INFORAfATION I.G7TER GIVEt:: <br />CIi_4RG�S <br />(1) Sueicc rosia�laiion S cunnccuon chargc <br />(21 Gcncral Paciliu:s cnr.nectiun chmgc <br />(7 � 011tct <br />; / <br />c . . , '� ) <br />i., n. . �. <br />_ � S <br />Tot.il anmunt rcttrccd �vth appliuuon � . <br />IT Iti UNULI:S'�I�UU Ihat �his Apphc:vinn, alihnu,_h signed, sh;dl not b: binJine upon �ic AtU1:ILTEO R'ATER DIS'PRICT umil appwveJ bp th: UISTRICI' <br />I. the undasiEned. owner Inr repre,cm:nrccl ofth: pmpcm� des:nheJ aM�ec do herchc mai:: app6eauon 4r in:iallation otn � -inch diame�cr w�ate: suppli <br />un ice connccuon, including appuncn:n:cs,:md:Jl ncccssun� lahn: at mv c�pcma. <br />Uatcd Ih¢ ___ d:n� uf _ � - . <br />'"-.'-~-'�---_ ..:� <br />APPLIC,IN��S'tiIGN:1TUlt![�.-- i'; : � __ _ . <br />Apphc.mi s Num, lPic:sc pnn0 _ � � i �," � �'"/'� - � ` , — _ <br />I c{. ^ <br />'�PPh::mi s Addresc A Phunc �wnbu: • !.- . � / = i. � �L. . -• ' � � � ' h"� ,V'•. i � <br />i <br />CROtitiCON1EC'iIONCON7'ROI.SUM1I�1:1R1'.ASSGSSNfNTI3:1C1:PL0�1'REQUIRED^ : 1'HS �� NO;,`/r:�Jr__.," �._.._� . . ..._- <br />'i\p: ol Decice Srz: of Uecic•�. CCS Inrtmis�. �� Dnm: / <br />i <br />:V'1'RO\'ICU;Y' AIU61L'fF,O\{':\"1'I:ItDltil7il("1' <br />.� , _ + <br />: „� �.�^ � r c <br />li��._ <���'� �� __'_— Datc- IssucdF3� __ <br />