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<br /> '. .�',: :.i�'e � {�, ''r ` � '� ';MU ' O MF�7ER OI�TAICT `.
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<br /> ' SNOHO I�SH COUNTY WASHINGTON
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<br /> ;.. ...:;, ,' '.a,r ' APPLICA710N FOR WA
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<br /> ' ApplfcatiQn No. � ��r. J -_� I'� No.
<br /> �
<br /> � Meter Size Nur�er of Units •._ ��M�• �.oUp
<br /> � 1 hereby apply tor water senr�e and.agree to be povemed in accordante wflh the resolutbns, rul�s and regu atT bns ofthe
<br /> � MUKILTEO WATER DISTRICT pertafninp to water service, now or hereaRer in ettect. The understgned as owner or
<br /> represemative ot the herein-descnbed premises hereby agrees as fotiows:
<br /> (1)Thet the�at of arry eicoanaon of the water tervioe,renewel,repacement or repair b nach and cerve tha properry d�+seribed slull be borre
<br /> ' by my�H or ucigns u owner(e) of tha premfas.
<br /> (2)That all pipes�water measurinp devices erd otheroonnsctlnC squiPmeM W�veam hom 1M mebrsh�i,�hertlroirlronAatlon�be rid becoms
<br /> the propery of the MUIOLTEO WATER DISTRICT,subj�U b d b repulatlms p�rt�InlnO b wabr wrybe.
<br /> _ � . — (3) Th�leflerL•uWladon�NmaMror-meea�-boxndappuYnwsarobulad e^_.
<br /> (4) Thet 4he MUIOLTEO WATER DISTRICT,hs oRw�n�rd p�nb,�he1 ha�+tM ri7ht o(inpraa ud preu ro po upon ihe premises end pioperty
<br /> M�
<br /> �d�w�ibad Mreln br the purpo�e of inspectlon�aonn�ikq a d�oonrrelFW IM Nrvla a ta au�h othx purpo�ss u the se N r�quiro.
<br /> It Is dw undertlood durinp the Bme Ihat eny of M w�Mr msiu m�y be out d�xviw bY rouart of ury«nerpency a Ynpro Ihori=ad
<br /> by the DISTRICT,M any atreet or ottix bc�fion in which tlwl m�Y !rM b�e^�dd,�DISTFiICT wi9 rrot be requlrod eo lumisFi ater durhq
<br /> the propreu ol sueh impo�am�nb b any oomum�r wlaw tupDN may thw a a�oR,a h�YbN lor�ny drMOn fa in h9ws to do a.
<br /> ,xCS) That the DISTRICT shdl h�w Ihe ripM b ch�npe Iha�aln�t�nY tim�DY Rawlutlo^�b ter^P°�arAY diwa^tl^w Ihs�ervke to oonsumen,md
<br /> ro inemA the meter(c) ro rpbtw M�s wa�x consumed. TM DISTRICT�tul not be Iwld i�bla br damape bY wa�er orolher awe rewPorq ham
<br /> . detectiveplumbingorAFPp�nwsinaWkdbylheawneraocapudonlMP�knwppiedwhhwabr��ndlhehcttl�atapen4oftl�aDI3TRICT
<br /> may hew Inspeered ths plumdrq rid�pPGances sIW noCba plad as�buh br reoovery in am of dampo u aloraseid if tM wppy of � .
<br /> wetwsh�N fall a be(nt@mlptad by reuon of acddem,low pres�un aolhr;au�e wh�hwvw.Ihs DISTRICT�hdl notbs MW qeble ford+mpec
<br /> � , nor ahelfiuch feiluie'dintam�ptbn br eny reuonabie tlme be A�Id b c:,nstlUrte a Meach of contr�ct on the pan of the DISTRICT or in ury way
<br /> �• r�Yiva.lt�qpn�ymir�wlwthar annt ar avror.(rom pwbnn6q�obAp�tlon of wdi MnanC�a wmar�oontr�ct. W�er,�hdl ba w�d by
<br /> appReaM ot�Y on IM pram{sea dssaibad Mrein. A rww�PPlfcatlon Nrl W fAed�haiN w�ow b�dnlred for otl�w premiai�Mwuph loeated
<br /> ��� ��' .00 IanddascrWed hwafn. .
<br /> �vc-:(8) Th�t th� DISTRICT noomm�nd� Imhlutlon of � pr„�un ►puUtinp vdw. Appikant adcnowl�dp�� InlomuUon u to da
<br /> � ncomm�nd�tbn and uwms�full rupondblllty for Imtallinp or hllinp to Indall a pruwn ryuwUnp vdw on th�w�w ryslem to
<br /> ,iprot�ot It hom hiph pn�sun.
<br /> ..- �.��(� Th� DISTHICT utlUza�oh�ck valvM�t tM m�ur a pnwnt w�Mr ntwnlrry to iM Dbukts mvna. Th�DISTNICT rwomm�nds �
<br /> � . InHall�tbnofatMmul�xp�ndonunktoprw�nt�xo»�IwpnawnbulW�upoau��dbyth�wntKlwur.Apptldnt��dcnowl�d�a
<br /> �Inform�Uon u b�noo n�nd�uu@N tuG rs�pu�dblltY tor Imt�llinp or hpinp�o ImWI�th�rmU ncp�n�bn link: , , ,
<br /> �..' � � .
<br /> I SERVICE ADDRESS: �L�� LOT NO. BLOCK
<br />, �� "i PU�T/�NAME• �
<br />, ;_,,�;{, ",''`,''
<br /> �.���t- _ LEc�A�DESCRIPTION:
<br /> � �` CITYSTATFJZIP: .
<br /> OWNERS NAME: ���� C��"�
<br /> OWNERS� ADDRESS: /26 L f � AI.`�>A/� M�OY
<br /> CITY%STATE/ZIP: �V � �'"� 9�Z� —
<br /> The premisen are ro be used es a � (/� /,
<br /> ` ✓ INFORMI'.TION LETTER-GAVE/SENT: v
<br /> CHAROES:
<br /> �,>S�������8����,�e ; �ass.oc�
<br /> (2)Genera�Fac(Gues oonnection chWe f �.1"�`�" I
<br /> (3)�� , s U
<br /> . Totel amaunt received wilh eppicatlon . S I 0 I•
<br /> � ITISUNDERSTOODthetfiicAppGca6on,dd�ouphdpwd,duMnolbebY�iquPontheMUKI�TEOWATERDISTRICTun6l�pprowd�y/¢sDISTRICT. .
<br /> I 1�the undersiyned�owner(a represen tive)ol tha dataibed aDove�do hereby rvke appication br InstalisCon of a -IndP..
<br /> dwnemr water s �ervioe conn � ,and rl labo�at my expeneas.
<br /> � , . oerea m�:�aer or � ,�e�" . -• YA�
<br /> ' ��'�'• �,APPLJCANTS SIGNATURE: — E O �777
<br /> •;' APNicanCe Neme(please prmt): •�/I�f r A �o? O"Ci �
<br /> AppicanCs Addreas and PMna Number. �z8 z u - �lra... ,�.i k Wpj� DISIRIC►
<br /> i , A P P R O V E D: (;'=5) 3S7• 'TS7Z Cra.) ?/Y- � 20 � 1A���t�
<br /> MUKILT ATER DISTRICT
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<br /> I BY' ---' AaWC' /T ,
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