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� � '' . ' MUKILTEO VIIATER DISTRICT '� _/ v`/7� � " - ,C
<br /> SNOHOMISH COUNTY WASHINGTON ` �
<br /> APPLICpTION FOR WATER
<br /> - . _ � ;•. . _ � —
<br /> application No. _� 3� Na_ 9Q � �jyp� C
<br /> Me1er Size .�_�/ _ Number ol Un(ts �__ Accouht No. O�ca- �g0 n�a� Q
<br /> � �
<br /> I hereby apply lor water service and a�ree(p be govr.rned in accordance wifh Ihe resolNtions, rules and regulaiions ol Ihe (
<br /> MUKILTEO WATER DISTRICT peAaining to water service, now or hereafter in efledl. The undersigned asywneror
<br /> represenlative o!ihe herein-described premises hereby agrees as lollows: � _ �
<br /> I � ) �
<br /> (1� Thni Ihc cost ol nny eKtr.ntion ot tho watar sorvicr..rr,now�t, mplacemant m repeir ro reach and shrve Ihe proporry descdhod sMd be 6bme � ,c
<br /> by mysoll or ossigns ns ownar(s) ol ihv promisas. �
<br /> (2) That nll pipos,wator meesu�inp dovicoe end otha connocting oquipmont upstroem Irom Ihe motar dholl,eftor thuir Installation,be�d become �
<br /> Ihe pm�rry af Iho MUY.iLTEO WATER DISTRICT,Rub ro ell II5 ropuletions portaininp la watof serviw. C
<br /> (3) TFnt oltor insMlin�ion,il moror or motor box and oppu n ero buriod or dpmppod thny��_��Bld tosponsl6lo end cherged Por samo. �Q
<br /> mA
<br /> (a) That Iho MUKILTEO WATER DIS iqICT,its oflicors a d tt,shall hew lho�iQtit ol inp�oss end opross ta go upon iho promises nnd property C
<br /> iezcribad horoin lor iho purpose ol inspoction,connecunp or dieconnoctlnp Tho jt�rvico w lor such othor puryosos os the sorvice muy raqw:a.
<br /> h is olso underslood during the timo Ihnt eny of Ihe weter mainR may bo ovi al sorviee by reeson ol apy umergoncy or Improvemon!s authorized
<br /> hy tho DISTFICT, in ony stmot or oMnr location in which tha��mey ha�e hoen laid,Iho DISTFICT Gvill not 6e required to Iwnish water dudnp
<br /> tho pragrass al such improwmAnts to eny consumer whoso cupaly may ttws be cut oH,or be liah(e for eny demnpoc lor Its leiluro to do so.
<br /> (5) Th�:ihn DISTRICT shall hnvo tho ngM to ehango ihn raros et eny ume by Flesolution,to tomporanly�diseonGnsa tho sarvieo to eonsumors,onA
<br /> tomslnllthomotm(s) torogistnrthownlmeonsumed ThaDISTPiCTshallnotboholdliablofordemngebywatororothorcause�osullinglrom
<br /> tlnfecGvo plum6icg o�npplinncos instnllod by Iho ownor or ocwpanl on tho promises suppliod with wator,and tho IaC,Ihet egontF of tho DISTRI CT
<br /> may hnva inspocmd Ihc plumhing xnd nppliancac shnll not bo pload ns e hnsis lo�recovory In case o�,dmm�go es elorosaid. If Iho supply ol
<br /> wntcr shnll lail or 6n intovuplrtd hy moson ol accidont,low prossuro or othor cnuso whatsocwr,tho DIST.i�IC T shatl not bo hold IiablA tor demepos
<br /> nnr shall;uch lailmo or inlurruption lornny ronsonn6ln timo ho hcld to mnstituto e 6ronch of eontrect on Ihe part af Iha DISTqIC?or m eny wry
<br /> , ro6nvo tho consumm,whothor tonanl o�ownor, Irom porforminp iho obligallon ol such IonnnPs ar ownai s aontrnct Wnlor shall bo usod 6y
<br /> npplicanl only on th�,promisns dosaibod ho�om. A now appliralion ehall bc Idod should walm be dosimd for oMar p�amisos ollheugh Ixated
<br /> /�,� on land describad hcroin.
<br /> u�i�i/��(6) That the DISTRICT reoommend� In�telletlon ol � pre�suro reguletinp velve. Applleent acknowledpe� Inimmellon e� to Ihe
<br /> 1 reeommenda�:on ond es�ume�lut�responelblllty lor Inslelllnp or lelllnp to Inelall e pressurete0ulaling velue an ihe w�ter�ye�em lo
<br /> ��/, protec�I� Iro n hlgh prassure. �
<br /> �v��,�� �7� Tha DISTRICT utl l�es check valve� e� ihe meler lo pievont weter rewming to Ihe Dleldcts melna. The D!STRICT recommend�
<br /> r Inetallellonaleth�(eleYpenclontanklopravenlaRcee�Iveprea�ura6ulld•upceu�edbylhewcierheelar. Applicanttacknowledps�
<br /> . Iniormollon es In I�,rncommnndelian end a�sumes lull re�pon�lbllty for In�lalllnp o�Ielllnp to Inalell s tharmal erpan�lon tenk.
<br /> SEFlVI,.EA��R[SS� _/i/n�_�„� l��'—L�TF6--� � gLOCK —�
<br /> �7 0- Tlt*� '���
<br /> - ----- PLAT NAME: '
<br /> GTVISTATE/ZIP�. � �_ _ �—f- ��. �] ,/�2 � �/ LEGAL DESCRIPTION� �
<br /> //V�•LY7�'=7"1'7 ,-7 Z�To� -.
<br /> OWNER'S NAME���T�A_������y i
<br /> OWNEH'S ADDRESS: �/��L �y � �
<br /> � `� �7" ���/
<br /> CIT1'.'3TATE/ZIP: / ,i „ ,.� ��
<br /> T77vro ,
<br /> ihr premixo;xrc to bo usad ns a '
<br /> ----�� � ---- ' ��� '� INFORMATION LETTER-GAVE/SENT ,�"� � y ~'
<br /> ��� � _ .. . . -� �___TG
<br /> CHARGES� j ,
<br /> i1�Service inslellnuon 8 eonneaion chmgn $ �d/J .r�f �
<br /> —T--r� ,
<br /> I�1 Ganotel Facili�iec connoction tharga E ��� j!y/
<br /> (3)Other . S _ �
<br /> Totat emount rocorved wilh ppphraUon S
<br /> � / �t
<br /> IT I5,i�;;�E�15T7UC�thm thix AnDhcnuon,ahhouph sianed,shell not bo bindmg upon Ihe MUKILTEO WATER OISTRICFvr11c ep¢�a7�0'brthc DISTRICT
<br /> i
<br /> I ini�undr� �n�A, ownor�or ropresontauve)of Iho proparty descnbod ebovo,do horeby meke eppliralion formgMllation of a i �� -Inch
<br /> a,rruter walor supply sernm connoction,includmp appurinnences, end ell neces6ery lebor at my aMpensee� —'pAID
<br /> `7alod Ihis _ day ol- � �g ��
<br /> �6fi�7r—� '
<br /> a�rucnNrs sicN���r���,.����#� � OCT 0 9 19g0
<br /> App6,;anCs Nema (plan6o p •
<br /> �/
<br /> �cc��,-.n�rR nddress nnd Phon� N inbor f j��_��L,� �� � MUKILTEO WATER DISTRICI
<br /> APPROVED: � �
<br /> MUKILTEJ WATER UISTRICT `� ����9 �������y�/�H 1
<br /> s�G'- 3 fk G C�� �
<br /> �''��j�� -— - oa�e —����5,�_—
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