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�tUKILTfO'N ATGR DISTRICT <br />APPLICATtON FOR N'ATCR <br />Meicr Sizc: - r - •• , � • . �_1.0._ I <br />, � � tien�ice Address `��- �:� � �__�;� , , �- � � � Acct. No.: L <br />� �- --------- � --"-- <br />Numbcr ofUnits: �� n��,� 3 I y� <br />Meter will be used (or (checA nll thet apph��: _x Domestic ____ Irtigntion Fire Service __ __ Pire Line <br />I hcreMv npply for wmer service and agrcc �n hr Fnvemed, in accordence wi�h Ihe rcsniminns, rules ond regulauans of Ihe MUf:II.TF.O N'qTGk <br />f 11S'1'RI('"I (MN'P) pertninmg �n wnter servicc. nnH� or hercnf�cr m eflect "Iha undersiFncd n� mvncr or rcpresemative af Ihc hercin-described <br />prcmixs hcreh�� nFrees ns fnllou�s� <br />� I I 'fhe mnsumer eFrcu tn ms�nlL nperetc enJ mnmiam ai pIi Umes, Ihev plumbmF syslem m cnmphnnu wnh Ihe eurteni edman nl lhc limtorm Plumbmg <br />Code d, n penem� tn �he prevemion of conlnmmauon, end prnlecunn 6om thertnel eepenvnu duc io e dnsed sysicm thni could nccur wuh 1he prcsem m <br />(uWrc ma�xllntinn nf hackOnw prevenlers nn lhe cnnsumer's semce endim ei plumhmg Gxtum <br />(?I 7'he cmisumer egree� �o inrtull nIi he:kllnw prevenlinn accemblics rcqucs�ed h)� Ihe MN'U, nnA In memtmn Ihose I.eckMw picvenunn essemhhes in Kexid <br />wurkmF orAcr 1h� ncttmhhcs shell br nf n rypc, svc nnd mekc epprnved hr Ihc A1N'U end Ihc U'u�hmFton Sla1e Ikpertmrnt of {Icelth ANhonry The <br />assrmblrt� shnll hc rostallcd m eccnrdnncr wlth etl stnndurJc rslahhshcd hi Ihc M\l'U <br />( t i 'fho wm<i mecr xill nnt 6c roslall<d umil e wamr uce xune� ha+ heen suhmnmA h7 Ihr npplicenl nnd Ihe Uislricl. Cross Cannecuan Comml Specislist bss <br />dcicrmmcA dlhc cu�inmcr wlll nceJ m mstell a AnckOnx prcvem<r nn lhc cuslmm�'t siJe ol Ihe mcle� <br />141 Thel Ihr �on nl nm enemmn nf Ihe we�er scrvitt. renew�aL replaament rn rcpau m rcech nnJ serve Ihe prnperh� descrihed sheil be M1ome by mysellm <br />drvEn� e� ax�ncq � i al Ihr ptr,mtsa <br />( 5 i Thnl all pipn. xemr mert�unnp d<v¢a end nthei cunnectinn eympmem upnream Gnm Ihe meler shalL nller Ihnr mslelleunn, be end M1ecome Ihe pmpeny of <br />Il�c MN'U, suhlrcl tu nll ile rtgul8imnx petlnminF In uumr cervice <br />n� � Thet elmr inanllennn. d m<Icr ur maler hnx and pppunenenca arr Funcd nr damepcd. lhc owner, will hc hcld respnnsihlc end chnrpad for semc <br />f' i 1 hr�� Ihc M0.'I�, ns ollicers end epeNs. shall have Ihc nFhl nf mpress end cRrus 1n Rn upon Ihc premisn and prnpcm Jcscrihcd hercm fo� Ihc putpnsc nf <br />in�.pcctinn, cnnnecUnp m AiscnnneclmE Ihe sernce nr Inr such atliu purpa�n ae Ihe xerv¢e me� reqwre li is eku undercinnA durmF thc nme Ihnt enr o! <br />ilu� Hmr ninint mm ba nm af sen�ac M� rens�m nf em emerpenn nr imprnvemems mnha�ved hy Ihc A1N'1�, in mrc slreei nr nther lucnunn m uhich Ihe� <br />ma�. nmc heen Inid. lhe MN'U will nnI hc rcqwmd In fumish x�mer Aunnp. Il¢ pmpicss nf xuch �mprnvemem, in en� consumer whncc vipply mn� tlms he <br />cw �dt. nn c� Lnhlr lur nm� dmm���c. Im �u. lmlurt lu Au sa <br />I F� l h�it ihc A1N'l l shull hnvc Ihc nphi lu chnn�r Ihc rmn nt om I�mc M Resnluunn. in mmpnreN> e6e<nnunuc Ihe sercice In canaimcn. nnd lo m�t�dl Ihc <br />m�i. u s i u� �cgiaci thc wa�ci cunvumcd 'Ihc MN'h shnll not hc helJ Imhlc fur dnnmpc hr wnicr ur nther cauxe rcadung Gnm delenrvc pinmbmF n: <br />npphn(�ixs�h'q11cd M Ihr awncr m ucnipnnt nn thc pmmisco-tfpplg� wJ th,gntet, end Ihr fnct Ihm epcnic nf Ihc M WI � mn� K�vc rospcctc�lhc plumhmp <br />anil nppha�cc� shull no� hc plcnd n� e Aacn lur mcnrcn in casr uPJehitf�r �r,lfnrtseid I! lim supph� nf walar shell fail or ha iniFinip��mn" <br />.r.ndem. InN prcxturt nr uther cnuse whe�soo�er. Ihc AIN'Il shnll nut hc hclA hehlc liv Aemeges nni shnll suc6 lailurc ar imcrtYp�i��n Inr em reecnneble uma <br />b�CIJ.u.mnqnum n bmnch ul comract an Ihr pnn uf Ihc AfN'1 � �� m em wn� rcheve INc cansumrr. whether Ienwn nr nHncr. frnrii perli�rmmg !hc <br />��66r�mnn ol tucL mnnn��+m uwner e coNracl \Veler thall h: u¢d h�� apryl¢enl unl) nn �hc prcmises described hvcin n o.:u :���i��au��.�:nou nr ei:e <br />,huiild NNlrrhr Jc�urd Im nther premnn nllhnueli lacmrd nn IanA desentrrJ herem <br />�'I� Ihil Ihr \I11'U rtrnmmrnd� imlallulinn nf � prrsiurr rrFnlalinF ���h'e Applinm ecknnaltAKn infarm�tinn �� lo Ihe rtrnmmend�llnn unA <br />ur�umr� fnll rr�pnmibilln Inr in�1�IGnC ��r f�ilin� Iu mclall u prr�avr rrFW�tfnA ���Irr un Ihr w�lrr sw�rm to prulrrl It Bum hi�h <br />prtsnirc . � '� 1\"1. <br />11111 �1'he !NN71 Wilivrn c6ecA culrro �I lhr mrin tu prrvrni enlrr relurnm� lu t6r Iharieh maim. 'Ihr �I\\�II rernmm�nA� mctalla�inn nl x �hrnm�l <br />a�pxm�an lenk In prrreN rv��u�r prr.�urr hulld.up rawrA h� Ihr enrr hranr. Appl¢�m u owlrJkn fnfarmaiinn u� iu Ihr �ernmmrnJab�m <br />and i��umr� full mpnn�iLilii� Im mciullinF ��r lullin� lo fneull � Ihermd espansinn IanA. C�� IA'1. <br />. , (� <br />til I±\'If�l AUUlthtil^ �._ __ . _1 ' 1' y. <br />i�ill"tiI�I�P./IP _ . . .� . i I .,J._ �.� <br />� i\YUI(!t'S NAMb � . ._ � �" • <br />; �wN!,u�s nnnars` J�i_; � -i � I- I `�:_ <br />� rn;�srnrr.nr =— �T- -i�� :��—. -- <br />I hc picmisn vo Iu ha used �� e -'� l� <br />s! �Ii V�i l 7]�1�. <br />I �rrduper Insmllyd y _ <br />I n�vict Insinlhd <br />I h�vict Ins�nlled PuWrc— � <br />I(�fNO____ � ___Hl.n;l. <br />!'I.A�I�NAM!'. 17; ! , .I ._. � <br />I.li�i\I.DF.tiCIiIPTIOK _I_iy�_ .` �;-i ,�_ <br />iai.orrr:itn!irissui:nnr — �-,—;� <br />WPOItMATIOh I.G'ffliR (iIVF.N: ✓ .—.. <br />C11AI{4rti <br />11 I lcrvicr tm�nllsunn A connccuon cherpc <br />1'-I (i[ncrel fenln¢s connecuon cherFc <br />13�(Mher <br />l olel emnum rcccircd e nh epphcnlinn <br />i.� � <br />Sv� . i.:�` <br />f _; � - l <br />f <br />S � ' � �� _. <br />I i Iti UNUf!RS'Pt N�U ihet �hu nppimelion. ahhouEh siEnrd, xhnll nm bc hmJmg upnn Ihc A1Ul:ILT[O R�ATER UISTRICT until epprmed M ihc U!ti ; I! P�; <br />��A�u <br />! �hc undereFned. nenrr lor repreerntauvr� nf Ihr propena AescnFed aM�re du herch� moAc epphcmmn fnr imlelluion af e ` �mch diertic�c x;ur �uppi. <br />.er��me mnneeunn. mdudmE eppuncnwices. nnA nll neccssaq lahn: nt m� r�prn�r�. ( <br />I 4ucA Ihn . �_ do� ol _ _ _ ' ..... ' �'/�.(��� % � <br />---�,- / " G �L'� <br />��rri u�nn�t:•� swnn�rnkr r �, i //� — — <br />,- ;-, r. -. f .� - ; „, . , -- --- — -A7UI(ILTEO Ydti1ER Dl�ikl;;l <br />lpplmnnl'. Namo lPleasr prnnl . _ _ _ _ . _ '_ <br />_�L .. 14 % I :.,/.. . . ' j . <br />___— • __ <br />'�pplicnnYe AdJress 6 Phuna Numtrcr ___ _ . . ___ _' _�'_ � • • <br />� I;�:�C�t'�.�KNPI'77nV('u^INuI aihl•d�J'1 4titil'tiSMGNTPqCI:PItIN�NFQUIRGD' 1'Ii5 x NO ' <br />'. � p: ��t I reciu� Sirc of Ikeicc __,_ __ CCS Imliels � ii � Date .�"� /� i�-� -. <br />�� <br />�I'I'H(��j/�\II'All I�! 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