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� MUI:ILTEO N'ATER DISTRICT O
<br /> APPLtCATION FOR V�'ATER O
<br /> Meter Size ` �4 Service Address: �� ^"'� �� – – '"%�'f -='' _ Acct.No.: I db�� �
<br /> _.J
<br /> Number of Units�— �
<br /> `�vieter will be used for(check all that apply): ✓ Domestic Irrigation __Fire Scrvice Fire Line
<br /> I hereby apply for watcr service and aeree to b:go�cmcd, ir acwrdance with th:resolutions,rules und regulations of the MUfJLTEO W ATER
<br /> DiSTRICT(MR'D)penaining m watcr servicc,noM�on c�reafter in cCfect. Thc undcrsigned as owncr or representative of the hcrcin-described
<br /> prcmiscs hereby agrces as follows:
<br /> (I) The consumer ngreos to insmll,npemte and mnimain nt all times,thcir plumbing system in complixnee H�ith the wnent edition o(Ihe Uniform Plumbing
<br /> Code az it penains m We prtvenlion of coNatninntion,and pmtection fmm Ihertnal expansion due to a closed system Wat could o:cur with th:present or
<br /> fuwre installation of 6ack(lou�preventers on�he consumer's:crvice m�d/nr at plumbing fixwres.
<br /> (2) Thc consumcr agrea lo install all backlloa prcvcntion a5scmblia tcqucstcd by ihc Mq'D,and to mnintain thosc 6acAflox�prevcntion azscmhlies in good
<br /> working order. 'Ilie asscmhlics shall bc o(a typc,siu and ma}:e approvcd hy�hc MN'D and Ihc R'azhington SW�e Depanment of Health Authorit}�. Thc
<br /> uscmblics shall bc installcd in accordancc wiih all standards c;ta6lishcd 6y thc�1WD.
<br /> (3) Thc W�atcr meler will not hc insmllcd until a waicr usc survcy hu bccn submittcd by�nc npplic�nt and the Districa Cwss Connection Control Spccialist hns
<br /> dciermined if tlic customer will nred to install a backtlow prevrntcr on ihc wstomer's side of ihc mctcr.
<br /> (4) Tha;thc cost o(any cx�ension of�hc watcr scrvicc,ancwal,rcplaccmcnt or rcpair to reach:uid scrve Ihc property dcscribcd shull bc 6omc by myself or
<br /> assiFns as owncr(s)of thc prcmiscs.
<br /> (5) Tha:all pipes,water measuring devices and otlier conuection equipment upstrcam fmm ihe meter shall,a(mr their insmllation,6e and becnme the propeny of
<br /> thc MWD,subjccc to all its rcgulations pertaining to watcr scrvicc.
<br /> (6) 71m:aficr mstallauon,if mcmr or mctcr boz and appunenances xr:buriod or damuEcd,Oic m�:ner,u�ill be held responsible nnd ciiarecd for same.
<br /> (7) Thm Oie MN'D,i�o(Gcers nnd agen�s,shall have the right of ingress anJ egmss to go upon�he premises end prop:rty described hemin for the purpose of
<br /> inspectinn,connecting or disconnecting th:sen�ice cr for such other purpos�s as the scrvice map rcquire. It is also understood doring ihe time that any of
<br /> thc wmcr mains may bc oin of scrvicc hp rcason of any cmcrgenc}�or improecmcnl5 nuthorittd by Ihc MWD,in any svat or othcr location in which thcy
<br /> may have been laid,�he MWD will not bo rcyuimd to fumish water Juring tlie pmgress o(such improvements to am consumer�ehuse supply may thus bc
<br /> cut off,or bc Iiablc for any damaecs!or its failurc to Ju so.
<br /> (B) 7'hat ti�c M\VD shall havc Oic right to chanec Wc ratcs at any timc by Rcsoiutian,lo Icmporarily discontinue thc scrvicc to consumcrs,:uid�o install thc
<br /> mcmr(s)to rcgistr thc wamr wnsumcd. ih:A1 WD shall nat bc hcld liable for damugc by watcr or oilicr causc resulting fmm defcctive plumbing or
<br /> applianccs installcd by the o�vncr or uccupant on th:prcmiscs supplics with wamr,and Wc(ac�that ngcna ofthe M11D may havc inspectctl tlie piumbing
<br /> anJ appliancs shall no[bc plcad:�s a basis(or recovcry�in cazc af d:unagc:¢aforesaid. If Ihc supply of watcr shall(ail or bc inlertupled by rcason of
<br /> accident,low pressurc or o�hcr cansc whatsocver,thc MWD shall not b=hdd liabic(or damnecs nor shall such failure or intetruption for any reuonablc timc
<br /> 6c held to constitwe n bren:h o(wntract on Ore part of the MND or in any way relieve the cansumer,whciher tenant or owner,from pedorming he
<br /> obliealinn of such tcnanCs or mcncr's mmract. Watcr shall b:uscd b}�applicyn only on thc prcmises dcscribcd hcrcin. A n:w application shall b:filcd
<br /> shoulJ watcn c�JcsircJ(sr n�hcr prcntiscs althou@L locatcd on land dcscribcd hcrein.
<br /> (')) 'Ch�t ihc;NR'D recnmmcnds inslallalinn nf n pressurc rcrula�in�valrc. .\pplicnnt acknmvicdges infnrmation as ro lhe recommaidation anJ
<br /> _ assumes full responsibilih•fnr insmllin�or failing tu install u przs����c rcFnlating��al��c on tl�e�rntcr sys�cm In pro�e[[it Gom high
<br /> i � pressurc. ' �—I�T. - , �
<br /> __ (I0) �he�iR'D utilizcs chcck rnh'es nl�hc mder In prevent x�ater rcufrningln tl�c_UistriUs moins. 'fhe 117WP rccommcnJs insl�lla�ion of:��henn��l
<br /> espancion tank In prevent exttssire pressure build-np cauuJ 6r ihe waler,hra�lc�. "Applicant acknnwledFes inPormetion as to the recommendatinn
<br /> anJ assumcs full responsi6iliq'fur inslnlling ar(ailin�tn inslall a thcnnnl cxpcnsion lun1:.=I�T.
<br /> SGItVICEADDRESS: �.'-•`-�� ;'-l���'�j�:- -/,% LOTNO': ^ .`-ti f3LOCK:
<br /> CITYISTA'IFJZIP � � ��'- '`Jy PLATNAMG: �-%�' �-' -J��^S-� � �� '
<br /> ON'NGR'S NAA1E: •%^'1.• � � '' r i: ' ���/ LEGAL UESCRIPTI4N:
<br /> OWNr_R'S ADDRESS: i-•'-.•. ����.•�' ' �7'�•J
<br /> CITYlSTATFJZIP: �✓�'���'� �� OLDG PGRMIT 15SLJED 6Y: -�;'%•:.�!f:'.•'
<br /> Thc prcmisu erc�o b:uscd as e `��" INFORhfATIOK LET"CER GIVEN: ,
<br /> SFR\'ICE T\'PG� CNN2GFS.
<br /> :`� /. ,'����
<br /> D:veloper Installed: �' (1)Scrnec instnllntion&connection charge S ` � -
<br /> Disvict Ins�alicd: (2)Goneml Tacili�ies connection charge S �=� �-% !-'�� �'��-�
<br /> Distric�lnstalled Puturc (3)Olhcr ST
<br /> Total amount mccivcJ�ath application S - -` =��-�'�
<br /> IT IS UNDLRSTOOD Ihat this Application,although signeJ,shall not 6c binding upon llre MUI:ILTEO�NATER DIS'IRICT until approved by lhe DISTRICT.
<br /> 1,thc unJcrsigncd,nwncr(or rcprescntetivc)of Ihc pmpertp dcscribcd abnvc,do 1¢rebp mn�:c appliealian for installation of u -inch diamcter watcr supply
<br /> scrvicc conncctionJncluding appuncnmiccs,;md ail ncccssap�labo j+t my cspcns:s.
<br /> DaicJthis du)�of ��' _ �
<br /> APPLICANTS'SIGNATURE: - .-- .. —
<br /> _,_:, ,
<br /> n��,i��;��r:N�,�(ni�as:�d�cl: _ _ _ �r,,tiu-;�l n i�
<br /> .4pplic;uiCs Address ti Phonc Num6ec � ' ' r., ,M1,���I
<br /> y �I I.:,,� � �---I �l
<br /> � CRO55 COI�NECTION CONTROL SUMMARY ASScSSMENT 6ACKFLOR'REQUIRED? YES /\ NO � c5 i f, � " -Y' �--
<br /> TypcofDevi:c Sizco(Uevic:: CCSlnitials:��.G/ Date: / c-�
<br /> A2'I'RO�VI:D.r� NUI:IL7'EOR'ATGRDISTRICT /`�� � --'--
<br /> ��,: .j'f-�j/� Date: L'i!�/Z Oc7.V lssued��'-
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