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,.. y <br /> q' . .. <br /> • MUKIlTEO WA7ER DISTAICT <br /> SNOMONNSH COUN7Y WASHINGTON <br /> j(l- �o3s�0o <br /> APPLICA710N FOR WATER n�D�n� <br /> `� lf <br /> Applicatbn No. � �� N0� ,��r ^�'S��i <br /> Meter Size <br /> Number of Units AccouM No. '�'� "` <br /> I hereby apply for�ler service and agree to be govemed tn aocordanCe wkh the reso�utbns, rules and regulatans of the <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eflect. The undersigned as owner or <br /> represeMative of!he herein-descnbed(xemises herebY a9rees as follows: <br /> (t) Thattl�e asc ot aiy ezmnda,ot the rraler wrvice�renawd,repl�amer�t a ieprr n rwch ud wrw aw propeny da�aiMd dw be bome <br /> by myblf a aaipns as amer(s) of IM pnmiMs. <br /> (p) That al pipes,rratx mwwrYW dwia�s and atlrr aonrdin0�Q�P�W�^kan M nwMr�hY�dbr IIrF huulWon�W�nd bsaonN <br /> Uis propwty of ths MUMLTEO'NATER OISTRICT,�ubNct b Y ib npWtlian pwtdnYq b waMr rrvio�. <br /> (3) Thet altxiroWaYon��m�Yr a mslar boz rid�PPurrnws re bvbd a driup�4 tlr an��vA b�Mid raponsibN�nd durped ror wne. <br /> (4) Thattl�eMUIOLTEOWATERDISiAICT.i1solRanrdpaen,�IWlrNMApltdtnpw��ndpn+abpo�onihepiartikssandWePMq <br /> desrnbed herein lor tlr purpow of in�tlon�4�0 a dmr�inY Yr wnAa a for wch oMier pupo�es u th�servky may reqiiio. <br /> n ia ako undeneood durMp Ihe mro th�t+nY d tlr waM m�Yn m�Y b�an a wnio�M n�wn M rry wnwp�rwY a���b autlariad <br /> by tl�e DISTRICT.in+nY strsst a Wher bcaion in whidi tlNY mry IrN bw�I�id(A DISTRICT wil na ba nqui�d b hxni�h wux�xirq <br /> iha popna d woh impo�rm^b b rY�wlww�WdY�Y�+s E�aul dl�a b�i�bM la rry dr�p�t for Hs t�b do w. <br /> (5) Th�t tla DISTAICT�IW hWs M rfpht eo chnp��M rabs�t�ny dm�Ey RroY�lbn�b MmDwrN�anWw tlr rrviee a oonwners�and <br /> bimtaAlhsmelr(s)rorpiswtl»wtleroauinrd Th�DI3TRICTdwlnotb�IrWl�6bbrd�nap�bYw�YraWhanws�aadtlnplram <br /> ,n�i,h�,.in��pecW nr«��•�'PP�'�noe w�p..a�r.�br�y�N�a�.mw. �.aa.�.id n�n,.D�a <br /> - we�erahdhilarbsir�lsnuPqdM��^daodd�rR�bwp�sKnaoMraurwfrbo�w►�MDISTAICTsh�MnatMMldlf�6blord�mps� <br /> nar shel wch hilure a in0emipNon branp rwa�bls dm�bs hdd b aomYe�s a bn�h d aontr�cton Or prtof tlr DISTRICTain anY�Y <br />� niew tlie aonw�Nr�whMwr tanne a awner�hom Vwla^N^0 ri�obip�Yon a wfi w�M.a ow�wfs oantact. wNx tlwt bs wad by <br /> �PP��Y��P�dawibad heroin. A mw applieYfon dW b�li�d d�aitl w�a M dasind ta o0w paN�w�Itlw�qh lacwd <br /> on land deaaasd IrreY�. <br /> � e) r�ommw�lbn x�d�l�ull�►MPo�+Iba1Y for ImullYq a bMnp b IIqtW■ptMwn,►�Y• ul��� onN tM�wMr sysMs b <br /> ` proMct H han hl0h Prwur�. <br /> Rrt (� 71w qSTAICT ul�s ah�d[vdvr�t tl�ImM►1q Prw�nt w�Mr MunlnO b 1M Ob4bh�dm. 7M DISTRIFT nroins�nd� <br /> InWtl�tlondatlMnndup�mbnhnkbpnv�nt�o�uli�+Pn�wnbulld�uVouwdh�Yrw�Mr1�1K.AYP�onM�nO�1�dY�� <br /> MMmwtlen r tM n rd lull rrpontlbiry br b�w hrnp b Insuf�tlwmY ap�n�bn mi. <br /> SERVICE ADDRESB: ��'Un��� � ��, ,.K <br /> PLAT NAME� �V� l IrU� <br /> CITY/STATE/ZIP: <br /> � LECaAL DESCNP710N: <br /> OWNER'SNAME: � • /�//L�� l''dSf <br /> OVYNER5 ADDRESS: � '`, u� <br /> CITYISTATE/ZIP: � �� � ��. <br /> � i <br /> The premia�n are n:be uwd at a . <br /> INFORMATION LETTER-GI1VE/SENT: <br /> CHARGE3: ���y <br /> (t)Senice inatdletbn a oonnection diarpe S �}�C6� �U� � S � <br /> (2)Ger�aral Fadlices connxtlon cturya S � '-I'i��J� <br /> MUKILTEO WATER DISTRICT <br /> t3�� s — <br /> Tonl amount reoeiued wilh appRcatlan i <br /> IT IS UNDERSTOOD Ihet this Applirafion.all�a+Oh� ,+Md^a be bind Ihe MUKILTEO WATER DISTRICT unE7 appoved qy�e DISTAICT. '' <br /> I,the underai9ned, (a roWeeentau 1 dsaaihed Iweby m�ka�ppin0on br inildlrEon d a f -Inch <br /> diame�er water��e conne�tan.i rMn�r�c++� labc►at my expsnus. <br /> Deted this �Y of , 9 <br /> APPLICANTSSIGNATURE: �K �N�� <br /> , �/4 • <br /> ApplicanCa Name(please print): _ <br /> �toS' v. <br /> ApplieanCs Ad�eas ard Plwna Number: � � <br /> APPROVE �f r t�� ,PL <br /> MUKIL R DISTRICT <br /> ,j / 7/5 N <br /> BY: oar: <br />