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.C+. .;� w� � <br /> � �',' - �, y £ : �f •� {t"�y�.. ..��;, 'L ,. ' . � <br /> � ; . .� i �� 3 MUKILTEO`Wq3ER Dl�,�A.ICT .+ <br /> � ' ;�, ; ^ `�; � 'SNOHOMISH COUtr'f'Y WASHING7bN �^a0,3I ODD <br /> . � ' ,,, . _ . �� • APPLICATION FOR WATER // <br /> . .. l� qq0�88 <br />' Application No. \ No. _ � <._,iM- <br /> Meter Size J Number of Units Axount No. <br /> I hereby apply for water service and ag�ee to be govemed in accordance wrih iho resolutions;rule�; anC rey.�latbns of the <br /> MUKILTEO WATER DISTRICT peRaining to wffier service, now or hereafter tn effect. The un��ersfgned as owner or <br /> representative ot ihe herein-described premises hereby agroes as follows: <br /> . . (t) Thet the eost of arry ez0endon of tlie wabr wrvke.renawe�,rePl�wment or repeir eo reach ard serve the pmpery deccribed ehdl ba bome <br /> . by myself or asaigns as owner(s) of Cre premisei. <br /> ' �2� tl�e8prolpparty of the MU�TEO WATER STR CI sl-, ub�a�M Ib repul���rain�p Ep w�ter p�rvbe rtheir Imhll�d�d beoome <br /> � (3)_That atter InsWlatlon,it mamr or meler box rd appurlanoss ve buriod a d�maped,tha ownx,wW 6a held rnponcible and T for wne. <br /> (4{ ThetlheMUKILTEOWATEHDIS7AICT;itaolfici►ffTriiJlfpNi9;7twfA�wVw'dOhtroYlnyremrxfaprras.00pwpon�apremt�e p �.___. <br /> ,�cnbed herein for the purpcse of inspection,oonn�aino w dtoonnactlnp the wrvioa a fa sueh olhx purposes u the servioe�ma�jEYeqre�qw•'re. <br /> °R i�also underseood durinp the Gme tliat�ny of tlre weler mdns may bs oul d serviw by ra�wn of ury emerpency w improvemenKeulhorized <br /> Dy Ihe DISTRICT,in any atreet or otlier be�tlon in rfikh tlwY�Y �w�wd�e DISTAICT witl not be iequlrW blumbh watx dudrp <br /> ' �a pmpnu of such(mprovemenb b any consum�r whos�tupply m�y thus ba aM oH,a ba A�bie 1or�ny dam�pea la ih hilure ro do w. <br /> (5)`That the DISTAICT ah�p luw tl�a ripht ro ehenpe tM nlas�t�ny tim�by ResoNNm,eo tomporuily di�contlnue the�orvke ro conwmara,rid <br /> , po insnM the mew(s)torapb�ar Ihe wamr wnsumed. Tlw DISTRICT�hd not b�Mld N�EN ford�m�ye by walarwotMr ause rewMarp Gom <br /> de}ec6w phimbNp aappYarwe�inaWled by Ihe ownerorooapeMon the premt�n wpptledwNh w�far,�nd 1M fad Ifiate{�enh of Ihe DISTFiICT <br /> may haw h�peded the plumWrp r�d eppRances�hell not b�plud a a bnh for reeovery In we o(dem�pe u etoresdd if the wppy of <br /> � wamrsheMhilabsi�Mnupmdbyrouonof�cddaM,bwpreauroaothxewwwhehoewr,MaDISTAICTehellnotbeheld6abkipdamape� � <br /> ' .: nar stW sud�failure a imertuptior Mrany reuanebM ' be he�d b aonsdwte e brweh of oonwct m the pvt of tha DISTRICT or in ury way <br /> Mi�.yi,,/ :�, mAaw the aonwmer,whalher ten�nt a owner, inp Ihe obiy�Non of wch IananCs a amers conEr�t. WaSer aheJl be uwd by <br /> ,�. . ✓ �``"'.�:'�,ppYdnt aiy on IM premises desaibed herefn. A n iwtlai sheM ba IYad�hould w�tx be desired la otMr prembaa eMlwuph loeabd <br /> �M Ivd desabed hwein. .. <br /> �. 'fhu 1M DISTHICT neomm�nd� Inapll�tlon of a pnNun rpul�Unp valw. Appliant �dcnowNdp„ Inform�tlon �s to tM i <br /> WT' � <br /> * : :noomm�ndatbn�nd uwmes full nspondblliry lor Imtdling or hlll�g to ImWI�pn�wro rpuuUnp rYw on th�w�t�r�ys4m�o <br /> Uot It hom hph prawrs <br /> �,���'�i DISTRICT uWues ch�ck valva�t tk�m�ur W pnv�nt waNr ntuminp to tM Dbn3cu m�ina. Th� DISTRICT noomm�nd� <br /> In�upaW n of a th�rm�f�xp�nslon Unk to prw�nt�xcwYw pnawn bulW�up a�wd by tMw�W M�pr.AppllaM��oltnoM�dpu <br /> Inlorm�Uon w th�ncomm� bn�nd■ ump lull rppondbllry for InaWIMp or hpinp lo InHaU�th�rmd ap�ndon tank. <br /> SERVICE ADORESS: ��D� �-'— � LOT NO. ' BLOCK _ <br /> PU1T�E: � ;. <br /> CITYBTATFlZIN: I.EGAL ESCRIPTiON:�I <br /> OWNER5NAME: ��kE �p'OKE '� <br /> OWNERS ADDRESS: I Z Z � �. c�qy <br /> CITY/STATE2iP: � � � � <br /> The premises are ro be used u a \ � �� �t� <br /> INFORMATION LETTER-GAVE/SENT: � <br /> CHARGES: �� <br /> (1)Service inamlbtbo 8 conneaion charye S � ��•�/) . <br /> (2)General FaciGties connection tharpe S ' '� .Ov DEC � 0 1�- . <br /> �3�°"�` s � � MUKILTEA WA1ER DISTRICT <br /> Toml amount received wiM app6cafion S <br /> IT IS UNDER:?TOOD thetthis AppGcedan,el�houGh cfpned,shsA not be bindrp upon the MUKILTEO WATER DISTRICT until ep�row� DISTAICT. <br /> I,the undersipned�owner(a rep�esentafiye)o(the de�aibed ahove�do heraby m�ks�ppintion ta InstallaEon ot� �_�nd� <br /> .-. diameter wamr con ,�nd vl r�[�uy laba�t my expenses. <br /> - Dated this��deY of J9 `T7 <br /> APPLICANTS SIGNATURE: <br /> ApplieenCe Name(please prinq: ���F �A �'t�[ <br /> ApplicanYsAddressardPhoneNumber: �r�Zg� /�UQN17A�s. t/AY 6{'� kq1 �/Zo / <br /> APPROVED: �y�S�) SS.S- 3t7 3 ('�a 1 '�/Y- /Z v 8 <br /> MUKILT TER DISTRICT <br /> � oere: Z / �q� <br /> By: � <br /> � <br />