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, <br />�1UhILTF.O N'ATF.R DISTRICT <br />APPLIGTION FOR WATER <br />Meter Size "i�" Servicc Address: ��' ��� � ����=� � "-� � <br />Number of Uniu:% <br />'Meter will bc used tor(check ell that epply�: _ V_ Domestic _ Irtigation _ Firc Service <br />Acct. No.: �Q� (� <br />r�soa��� <br />P�re Lme <br />1 heteM eppl}� far weter vervice end aFree to Me pnvcmed, in erenrdence with the resolulmns, rules und regulations of thc MUF:II.TIiO N'A1T:R <br />DISTILICT f�iWDl peneinmg in wnter servicc, nnu nr hortoller in effecL The undersiFned ns nwner nr rcpresrn�etive o(the hercin•described <br />prcmices hcrebp egrecs ns fnllnws. <br />( �) Thr consumer �greet 1n mvnll, aperetc end mmntun et dl Umes, lhnr p;umbmg syslcm m«�mphence wnh thc curtent cJlunn of Ihc Uni(orm Plumbmg <br />C(1de a� il �Iennlnl lU �Ile prNcntion of cOnW111NtIo0, uIJ prolccllnn (mm Ihermel cMpenslnn duc la n cllKcd Syitem lhel cnuld �x.cur wl�h iht preseni M <br />tWure mstallsunn olheckOnw prcvcmns nn Ihe wnsumer's scrv¢c endinr et plumhmg GKuues <br />('-1 Th: consumcr e�trees tn mslell dl beckOnw prwonUnn acsemhhn rcquc.�cd h� �hr MW'D, end In meminm Ihmc heck0ow� prcvemwn esscmhhcs In gnM <br />xvrkmF nrder Thc acscmhlles shell bc o! e IVpc, sim end mekc y�pmveC hr lhc MW7: •sd thc Naahmglnn SWc beperimcm of Ilcallh Authnnry '1'hc <br />� usemhha sheli he msulleJ m eccnrdenee wnh ell sundmd. estnhhch<d hr �he MN'U <br />(� I Tha wam meter wdl nm Irc msWled umil e wetar use eurve� ha•: been suAmmed Fc Ihe y�phcant end Ihe DutncLs Cmss Cnnnecuon Conunl Speeiehsl hd� <br />detemuncA if Iho cuclnmer will neeJ ta msull e be:kOne prevenmr nn ihr cux�omer's side of Ihe memr <br />ia i The� Ihe cnst a(mc ex�rnsinn of Ihe wuei serv¢e, renewal. replenmem nr repeu In reach enA swe Ihe prnpenq descrihed ehell be home hy mndf m <br />rt�siEn� n� nwncn<I nl lh: premises <br />1' i The� ell pipe+. xemr m:nwnnF devim� enJ olher ennnecunn eqwpmem upsveem fmm Ihe meter sheil, eller Ihe�r mstellelwn. be md hernme ihe pmpem ul <br />Ihi� MWU. sublca m ell ns rcguleuom pcnammF lu wnin servicc <br />I��i 'Iha[ nf¢r insull�uon, if mcier oi mele Mrx end �ppun<mnccs erc buned or datn�pcd, lhc owner, will bc held respanviblc enJ chuged lor semc <br />('i lhet ihc MN'U, a� nIT¢ers end epenL , shell hevc Oic nghl of mg¢s ond egress In gn upem Ihe prtmixes md pr�cnp dcscnlxd hemm fnr Ihc puqx�sc ol <br />mspeclmn, cnnnecunp m disrnnneclmg Ihe serv¢r ar for euch other pumases ac 1he servicr mnv rtquve li u elsn underva�d dunng the ume thet mv uf <br />Ihr wnler mems mec bc nw af scrv¢c M reasnn nf em� emagrncv or imprnvcmen(s �mhorved M� Ihc MN71, m em suttt or nther Incaurni in which Ihe� <br />mm� hmc bttn Imd, Ihe MH'U wlll nnt hc rtqm:cA In fumuh weler annne (6c pwERess nf such imprm emrnu lu em� consumer whose suppl� mnr �hm hr <br />cul nR. on c� Ilnhl< (ar nn1� dnmagcs lur it. lmlwr lu du so <br />i R� Ihel thc MN'h shnll hmc Ihc nFht In chunFv ihc rems ai en) umc hr kcsolminn, �o �cmpnmdly disrnnunua Ihc xmtt In conwmers, a�J lu msull 11ic <br />nmieqx� In register tlic wamr conwmed �Ihc 1.1N'f ) shell nnl bc hcld I�nhL far damnFc hr weler or alher ceusc resulimg (mm defecuvr lumhmE or <br />nppj�nncn in,y;IlcJ h} Ihc nwncr or nccupam nn Ih: pmmiccs supphe}-wrth waic�. end �hc fen �he� ngenu of thr MwU mec he�c m .m �hc plumhinp <br />nne(��Iliu�dea sYell not M pleaU nc e hnns fm rtcmm� m cnee nl dnmege p� ntu4wud if Ihc eupplr o( u�ler shell fuil m bc inlcdupmd h� rentun n( <br />ucudeni, Inu pmswre nr nlher cnuac wheboeree Ihe MN'U shell nm bc hAJ heMc fnr demepes nnr ehnll such feilurc nr mlermp{Liy�r em mn�oneble umc <br />hcL[4LW.wmqllmr a hrench ol comroct nn lhe pen o�ihe MR'Urn m enr wec reLeve Ihe cnnsumer, whelher lenent or awner. (rom perfnrmmk thc <br />nhLE+aunn ul si¢h Iennnl's nt nwneYx ennlrect Nsler shell Ae useJ h� n��i�oMi o�i> �m m� �«m�s« aes�dn�e n«��� A new epplmeunn shxli br fdeJ <br />chnuid wnia lil devrcd Im ntl¢� prem�se� nllhauFh IncemJ nn lend Jescnbed herem <br />1'4 �Ih�UhrR1�1'Ir rrcnmmrnds imnll�lfnn uf � pree�urr re�ul�finG rdrt. Appllnnt �rknnwlyd�es infnrm�tion �s In Ihr rernmmrnd�lion �pd <br />■uumo fu)I ra mlhilip for inqulGnF m lellin� lu Iwull c prneurr reF�d�linF v�lvr nn Ihr w�lrr ry�tem lo pmterl II trnm hiCh <br />prramrc i, f �11'1. <br />(Ilq I hr MN'P wilLr. chorA r�lve. �t Ihe mner In prevrnl wnrr rrinrnin{� lu Ihr Unlrlck mnins. Tha MN'U reeommenJe fmu0�tlon af � Ihermd <br />c�paneinn unA la prrvrm nreewr pnaurr build-up nuxJ b� Ihr w�ler hruer. Applinnt �olAorledRrx fnfnrm�linn �s In Ihr rernmmend�lian <br />�nd uaume. fnll rapomlhilm Inr ins�nllm;; nr hiling tu imull � Ihermd e�p�n�4nn I�nA. C_ I_ !.' IM�. <br />tiF:P\'1'.'I�AI7I7RPSS � ��.i. i � . /Y .% ; /.i. r <br />LOINU. � fIL(X'A___ <br />.i.—. . . . . _ _ <br />� .i� . .__. . _. <br />�'lil�'tifAf1�71i' -�� ' _ _.____ PI.ATNAMf[ ___'____� .; — ;^. ,•__� �__.._.__ _ . <br />. . _ _1-- - � . _ <br />� �N'4IiR'� NAMI. '=v' i ; � ' _ ' i.7 `� '!' `� LL'CiAI. DI;SCRIP'fION ���4 <br />- , . <br />�n��Nre:snnukrss ?5�� � % %��---- — <br />r,- . � � .. _ --- <br />� iiivsinn;zir � -�" , <br />l lic pmmises oc ln hc uscd as e <br />tiI R\'IS�CIILG.. <br />Iivvcloperinsulled __ V�__ <br />I�nincllnnnlled <br />!hanc; Instellcd fum�c _ _ ____ <br />^ ;d , '/�.�.....r <br />BI.U(i PERMIT ISSUED fiY � <br />INPORMATION L(7TfR GIVEN. <br />S�llAR9ES: <br />( I I Serv¢e mstalleuon & cnnnecunn chuge <br />1:1(irnenl I'eciGUa ennnecuon chuge � <br />(71UIher <br />iotel emnuN recerved with ��hceuun <br />S �,L��. 1 ��' <br />_ �' ^.. <br />S �',r . �. ... . . <br />f <br />$_T� . <br />IT IS UNUERS"f(%)D Ihsi lhis Apphcnuon. elthrnigh siFne4 shell na M1c bmdmp upexi lhc MUF;II.TFO N'ATER pISTRICi unlil �pprnved hy ihc UISTRIC! <br />I, !h< undemgned oxner I�n repmcentnlivci n! Ihc pmprm deunhcd �M+vc, dn herchy mJ:o eppl¢mm� !or vuulleuon a!e �/� •mN�6AMHer w�eter suppl� <br />sttr�ce <nnnecbon, mcluJm�� nppnneponce� nnJ nll necessen lehojyt mr evpenses <br />1191eJ �h�s Jm nl �� ' r^' ��� � J <br />- __ ,�. �--- PL�'�Y <br />nt�rt.icnn'rs siav.nri�ai _ �p"� --- <br />Apphcenll Nvne �plcau pnnu '' W _ - 1�- •` ��� V 1�• I Tf�` <br />_ __ _ %..,i_._ <br />Applicent'e Addms� & Phimc NumFcr . _ _.____ � � � ' � _ ' �- ( ✓;. � � , i • . <br /><'HUS�('(1M1T'I�i'llUti[1��'fR��I5I�M1INAP.YASSF.SSMITIT[1ACf:FIbN'RF,QUIRHD" 1'!i5 � NO <br />l�pculf�eece SirsnflY:vice____ CCSlnmds� !MI[ ��G/rL <br />1/� / � <br />- 6 2105 <br />�,'�. _'; ['�_T:....I <br />.. ' _ ..� ��..- <br />A!'1'NO\1, /,�IIAlIIF11NAI1.NIqSTR1(I <br />H� /�' ^ I°�--�"�- Uele _��' 1 C� ` IssucJ H� __ <br />� - , f--__.____ <br />_c <br />C <br />r�— <br />6 <br />