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' MUKILTEO �1'ATCR DISTRICT D
<br /> APPLICATION P'OR�l'ATER �
<br /> _ ,J ' — / . _,�...., i.�.,,,, , . G, Acec No.:����_9 n
<br /> nfeter Size: � Servicc Address: ' " -
<br /> Number of Units: y
<br /> � `Meter will be used (or(check xll that apply):Y_Domestic Irrigation Pire Service Pire Line
<br /> I hercby apply for water servicc and agrce io be govcrned, in accordancc with Ihe resolutions,rules and regulations of the MUI:Il.7'EO WATER
<br /> DIST'I:ICT(�4WD)pertaining to watcr scrvicc,no��'or hercaCtcr in effec�. The undersigncd as owner or representative of thc hercin-described
<br /> prcmises hereby agrecs us follows:
<br /> (I) 7T�c consumcr agrccs to insmll,operalc and maintain at all tims,Ihcir plumbing systcm in compliancc with Ih:curtcnt cdition of lhc Unifortn Plumbin�
<br /> Cod:ac it pertains m tlic prevcnlion of conmmination,and pmlccfion fmm lhermal txpansion due to a closed syslcm Ihat could o=cur with ihe pmsent or
<br /> fuwre installntion of backflou preventers on Ihe wnsumer's scrvice andlor at plumbing fiswrcs.
<br /> (?) Th:consume�ugmcs to install all 6ack0ow�prevention azs:mblics¢ques(cd by the MWD,and to mainmin Ihose backllou�prevention;usomblics in good
<br /> Hnrking ordcc 7hc asscmblics shull bc nf a ry�pc,siu ti�d mal:c approvcd bp thc MR'D,nd thc N'aihington S[atc Dcpartmcnt o(Hcalth Authoriry. Thc
<br /> azscmhlics shall be installcJ in accordancc wi�n all itandards csmhlishcd hy ihc bt WD.
<br /> (3) Thc u'ater mcler will not hc inslallcd unlil a u�alcr u;c survey has bcc�suhmi�md by thc applic;u�t and�hc Dis(ricts Cmss Conncction Control Specialist has
<br /> dctcrtnmcJ i(ihc cuslomcr will nccd to insmll a bnck0ow prcventcr on Om.ustomcr'S Sidc o(the mcMr.
<br /> (4) Tha!Ihc rnst o(any eatension o(We waler scrvicc,renewal,replaccmen[or repair to rcach and scrve th:propeny described shall be bom:by myself or
<br /> s:�icns u owncr(s)oflhc prcmiscs.
<br /> (5) 'I'lia:aIl pipes,x�aicr mcaturing Jevices and other conneeUon equipment upstrcam(mm the meter shall,after Ihcir msmllalion,be at�d btenme ihe prop=ny of
<br /> thc PnWU,subjcct to all its m@ulations pcnaimng to wntcr scrvicc.
<br /> (G) The:aflcr insmllation,if mcicr or mctcr boz and uppurtcnan:cs arc buned or damaccd,thc oe�ncr,will 6=hcld rcsponsiblc anJ chargcd for samc
<br /> (7) That the MWD,iLs ofGcers and a@cni�,5hxll havc Wc righ[of ingress and egress tn ga upon tlic premis:s and prapem descrihed hercin for 6ic purposc of
<br /> inspection,conn:cting or disconnectinc the sen•icc or for sucl:othcr purpos:s as tlic scn�ice may require. It is alsu understood during Ihe time that an)'of
<br /> �hc}vaicr mains may bc ou[o(scrvicc by rc:�snn of any cm_rFcnc}�or impmvcments authoriecd by lhc MWD,in any strccL or olher locution in which thcy
<br /> may havc hccn laid,lhc M WD will nol bc rcquircd 10(umish H�aicr durin�thc pmgress ufsuch impmvcmcn�s to nny consumcr u�hosc supply may thus h:
<br /> cut ufl,or bc hn61c for anp damagcs for iLa(ailure tn da so.
<br /> (F) That thc MN'D shall hnv:Wc right tn changc th:ratcs at any timc by ficsolution,to tcmporarily discontinuc thc scrvicc to wnsumers,and to insmll thc
<br /> nmlcr(s)to mgisicr lhc�oatcr consmncd Thc hiN'D shnll imt hc hcld liablc(ar damagc Fy walcr or athcr eausc«sulting(rom defcctivc plumhing or
<br /> appliances insmlied bp the owner or ncrupant on the premises supplics�ri�h w�atr,anJ�he fact that agen�s o(the M WD may have inspecmd th:plumbm�.
<br /> and apPhmic:s shall not bc plcad as n b;�sis(or recnvcry�in cue of damagc as aforesaid. 1lthc supply oC�eatcr shall(ail or 6c intcrruptcd by rcason of
<br /> a:cidcn4low�pressurc or alhcr causc whaLsncvcr,1hc M WD shall not 6c hcld liablc lur damages nor sh�li such(ailurc or intcrtuption for uny rcazunablc umc
<br /> b:hclJ to wnstiWle u bieach of cantmct on ttie part o(the MWD or in any�ca}�rclicve ihe consumer,w�hether tenant or oune;,Gem pedorming!he
<br /> oblieatinn nt such icnani's or a�aner's conuacl Water shall Fc uscd by applicant anly an the premis:s d-scribcd hercin. A neu�applicatian shall 6e filed
<br /> shnuld wv�ler bc dcsimd for otltcr prcmiscs nithougl�locatcd on land descri6cd hcrcin
<br /> (9) 9'Imt lhc;11R'D recommcnds inslullatinn of a pressurc rcgulatin��'alvc. Applicant acknox�led�es informu�iun as�o ihe rccnmmenda�ion anJ
<br /> -- asswncs tull.responsibililp fnr installin�or failin��In inslall a pressurc rs�ulu�inF eah�c on Wc wakr systcm to prolect il frnm hi�L
<br /> � presmrc INf.
<br /> ._ (10) The \1R'U utilizcs check�'ulves at Ihe mcter In prcven�x'alcr rctnrnin,�,In Wc Uistricls m;�ins. 'Phc DAVU remmmcnJs inslalla�ion of a lhcrmal
<br /> eipnnsinn tanL tu pro�ent excessiec pressure builJ•up causeJ by the waier hrater. Applicant acknowled�es infurmalion as to l6e recnmmendation
<br /> and assumu full rccpnnsi6ilily(nr ins�alling nr failing m install n Ihcrmal cxpansion tank_��'7�•
<br /> �.,�'v'�.:.,i _ ...' '!-� � /. =i
<br /> srtcviccnDrnzess: - , . i.orho.: oi.oc�::_ -
<br /> . _. . F�i.n r nnh�e: i �_ . _ .—
<br /> CI7'YfST,\TFIZIP: `�
<br /> � n �- � �'� � ' - � -� " LEGALDBSCRIPTION: ' �'� ' '�
<br /> O1�.t�3R'S NAME:
<br /> � ... ` _.�. .�:i,;�. �.
<br /> ON'NEIL'S ADURESS:_ - � � - ;.
<br /> . _.... , . ., r. � �
<br /> CITYIS7'ATU/IP: � � � � `'�- i3LDG PGiN11T ISSUED�Y:
<br /> '��'"� INFORMATION LETfER GI V6�:
<br /> Thc prcmiscs orc to 6c us:d ac a ' -
<br /> SHRVICGTYPc: CHARGF.S: �� ,j ,
<br /> Ueveloper Ins4�llcd: V (I)Scn�icc inslallmion S connection char@c S - y, � ^
<br /> 4;J, -
<br /> Uisvict Installcd: (?)Gencmi Facilitics r.onncction char@c 5
<br /> Distnctlnstallcd Futmc: (3)O�hcr �
<br /> Tomi nmuunt rttcivcd with applicatioo S � � _
<br /> IT IS UNDERSTOOD ihat this Application,ahhouch signed,shall not b=hinding upon�ic MUI:ILTEO NATER DISTRICT until approv:d by thc D!STRIGT.
<br /> 1,the w�dersigned,m�ner(or representalive)of Ih=prop:tty describeJ abnve,do hercby mal:c application(or inslallation oCn -mch di:nieter water suppl��
<br /> scrvicc connc,f„dnn.-incluJinF nppurrtnaices,nnd nll ncccssary.lphorv[my crpcnscs.
<br /> D:ucJ lhis . . ... duY�� ' .- �
<br /> :�I'PI.ICANTS'SIGNATURG�.' '� ._�- � _ `� � -
<br /> ���` n
<br /> Apph:yiPs Namc(plcase prinq: � � — �{ (� -7
<br /> '�pphcnnPs Address d:Phonc Numb:[ - �� � . .. . . ' � V i� �� �`-0�
<br /> .� �:l! '
<br /> � CROSti CONNEC7'ION CONTROL SUM�1ARl'ASSF:SSMG!.T UACKFLON'REQOIRED? � 1'E�NO' r �`/��
<br /> "I)�p-�f Dcr�icc: Sizc of D:�•icc CCS Initials: �+. Datc: .
<br /> / �1
<br /> ,V'PItO 'd,`O:/� MU61LTG0�1'A'CERDISTILICT
<br /> ��.. �����~ Datc/� Z/���� IssuedBy. "-
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