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MUI�ILTFO KATF.R DISTRICT <br />nPPLICnTtON FOR N'ATCR <br />AletcrSizc�. - �" ScrviceAddress: ���-%' � �� /��; �' - . �l. <br />Numbcr of'Jnits: - �- ----- — - --- — <br />Meter u•ill tie used for IchocA ell Ihat appl��)� __ V_ Domestic Irtigatian _ Pire �ervice <br />1 <br />�� <br />yl <br />���� N� 9 o_�a � J <br />n�o�is� <br />Pirc mc <br />I hcieh� nppl}' fnr weler xcn�icc xnd aFra p� hc guverncJ, in eccordancc wi�h lhc resolminns, rules end regulauons of thc MUKILT80 N'A"I7lk <br />I IISTkICT (MU'1�)1 penxining ��� N�eter servicc. nnw� or hereefler in el7eci 'fhe undersigned es owner or rcpresrntehve olthe herein-describcd <br />prcmiur. hcrch� ngrtes as Inllnws <br />� I i Thr mnsumer egree� tu mslnll. npermi nnA mnm�nm ei ell iimr, Ihcu phimhmg erslem m cnmphencr wnh the curtem edWon n(ihe Undnrm Plumhmr <br />Code u n penems lu Ihc prerrnunu n( cuntemmnunn. end prntecunn Irnn�� Ihermnl crpmsinn duv �n e clnsed e�•slem tliet could occur w�lh the prcscm nr <br />Poturt msull�uon n(heck0aw prevemm an iha ennsumer's urv¢e enJ�nr m pluminnF fivwres <br />1'- r Thc cnnsumer �grees In mslnll eil FeckOow p�rvrnimn axemAlin requetleJ bc Ihr MN'D, end lo me�mnm Ihnu bn:kllnw prcvenlron tieemhhes m g�w�d <br />wnrl:mp arder The sssemhl¢� shell hc nf e ry�p: •:ve end mekc epproveA h� Ihc A1NT7 end �he Wsshinpinr Stele Ihpanment of Heallh Authnnt}� "I lic <br />a�cemhlms shell he im�elleA m eccurdnnn• x�nh all slenJnrA� tsinblixhed M� Ihr MN'I� <br />� � i • ih� wemr meter wJl noi be mnelleA umd a wemr use �urvn ha�� been suhmm<A M Ihe �pphemt end Ihe Uisn¢u: C rus5 Cnnnecunn Cumrui Spemah<i ha. <br />dcl<fmined if Ihc cnslnmu x'ill nre:l N Inslnll n bnCkOnH prcrenler on Ihc customeYs SNe n( Ih[ meter <br />�4 i lhn: Ihr cnsl o! u�c crmnsmn nl th�� wnirr sen¢o rcnexnl. rcplx.emcn! ni rep:ur �n read� enA serve �he pmpem Ja:nhed shdl he lu�me hy myself ai <br />naa�m a� nxncn s i ol Ihe prcmnn <br />�`' I TIIII: �II �I�1C5. N'PICI Illflllllflll�' II[1'ICC� DIIII UIIICI LnpllfCll�lll Ct��II�pIC11111�15i1<II01 Ifup� li�t RltlCf SIIGII. lIICI Illtli IIISI�IIlIInO. ht �tl(1 IRCn(pc �IIC �Iornl� m <br />Ihe MN'f �. sub�ect Io ell ib rcFulniinn+pcnmmng io wnmr scrv¢c <br />i��i Thm �Oer ms�ellenun, d meler m metn hna enA eppunenv¢a ue burmd m dmm�gedJhe nwner. wilt br held respnnsihle enA cher�ed fnt semc <br />�', i Thn: Ihc MWI�, m nlf¢cn enJ npcnte, shell hevc lhr nghi nf mpmss eno c@mvi lu gn u�vm Ihc prcmimt nnd prnprrt� d:scrihcd hcrem for Om purpox nf <br />mspemm�. cnanecunF nr Au.nnneninF Ihe servitt nr Im such allmr purM�ms n� Ihe ierv¢r mm reqwrt h �� nlsi� understaid durmF Ihe ume Ihet em u� <br />thr wnmr mems �n� be uW ofservrr M rcavon a! em emcrFmin u� m�ninvcmcnl� qNhnrved M Ihc �7N'I) m env vree� nr ntller Incebon m which Ihr� <br />mo� hnrc heen h. Ihr MR'b xdl nrn hc rcywmA In lumish a�ater dunn� Ili pmFra� nl cuch improvemcnn u� nm cnnsumer whnse suppl� mny Ih�n h:� <br />cul all. nr hr haMc lur em Anmepc� lu� m. (xdurc In An su <br />i%� Ilmi Ihr A1N'I� shnll hevr Ihe npht w chmipe Ihc rnms ei em iimr M Itr�nhumn Iu temprnonh diccummur thi� eervin� io cnnsumen, enJ �n inslnll Ihr <br />mcirnu In repiqer Ihe wniu cansumed "Il¢ MN'U shull nni hc hcld Imhle Inr dnrt.egr hr wetu m otha ceuca resul�inE from Llecuvr plumhmg ai <br />:y�mna+�nqLIIcA M Ihr nwne or occupnm on ihr prcmisc� su mww;tli way,r end Ih[ feq Ihet opems ofihc �iN'U mm� havc m �cctcd thc plumh�nc <br />anrt npp7innc<� dmll nnt hi� plceJ n� o bn�i. li�r rccnven m cnu nf damiEck+liRv�t�}d u m� :u��iy or we�« <i�vi r,�i ��� bc ml�lul hy mx�on ol <br />u:uJenl. Inw prescurc ar otha ceuce xhat+never, thc MN'11 shnli nui hr hdd 6ehle Inr Jemeges nnr shell such fniNrc nr InlertupuanYor mp rensnnnM�� �inu� <br />h�� k�M+rtrtfhm�c n hrcnch nl cnmrn.� on thc pnrt nl Ihc �10.'l l nr m nm wn� mhcrc Ihc cnnsumcr. whelha; Icnmm �r nwncr, Rn�perfarminF� �hr <br />n6h�eaiion nl vu:L i:n:mt�� oi mwr• �+ i�nntrncl N�ntu shnll h: uud M arri�=nm ��,�i, nc Ihc pannses dcccndcd hrrcm A nrw npphceunn sh,+ll hr ld:J <br />�hnulilyalertf: �Ii��uvJ In. nlhr: prrmice� xllhnuch IncnleA ou Im�d ikanhed lir�rm <br />pIi I h�t Ihi \I\111 rtcnmc�rnd� InUdlaGan af u prrame re4ulqbnA �nlrr. Applir�m �rknuelydFr� Infnnn��inn n lu Ihr rtcnmmrndaliun ond <br />iµqim�. lull rtapnn�ihllil� fur In�lullinC ��r falhn4 In in.irll � prewnrr rtC��la�in� rah� nn Iho w�lrr q��lrm I�i prnitcl II f�nm hiCh <br />preunrr.. 1\ I . <br />(Ilh fbr 1fl1"II �pillin rhrcl, tahn �I Ihr mtirr lu prr.�m wulrr rrWrmn�; lu Ihr I/i�vlen munn. Thr �iN'I� rcnimmenJ.lnaylluiiun nf a �hrrmd <br />npaminu ��nA tu prnrnl nrc�enr prr�w�rr build-up nu�eJ bq Ihr Huler hratrr. Appliant �rknnxlydCec inlnrmalinn �� lu Ihr r^rumm nd:�lum <br />■nA awumr� lull rr�pnndbllin fnr imulGn4 nr fallinC ta in+ldl x Ihrrmd rip�nelon I�nA. �'. I4'1. <br />SIiIt\'I�.'I •1UUI!PtiS /..�!•:�• / ,= �:"� �:' ` � r I��I N(i Iil!��:l. <br />CI1�1'6-I.n�I-I� /II' � .. _! � � PI n I NAMC r% " :. f/ ' � •-� <br />'.._ . __.__..._____.. __ _T_. <br />ON'N:iN'ti N�1A11. r. • ' � I 'f ^� i/••• � -i' %y <br />_.__' ��' �— __�'r___._ I6:(iN DI'S('kIPTIOk _ <br />UN'NFIYt APDItI!Sti ��i!��j �" % ��� .� <br />CI"Il'SIA'1�1='/IP ��� �" .:�---�-��- Iil.IltiPL'RMI'I'ItiSU[URl' ����r-_--- �• �_��� -- <br />Thc prrnusrc mc �n hv uscd ds e_____ __ _ WPOk\IATInN LGT"fF:H (il VfN —� <br />�LR �'l4 I �_Z17'I�� . i'}JA1S4L . <br />n^.i i <br />Ikvdnperinxtellcd__ ���_ (Iltirrvm�msiu�leunn8cnnnccu�mchergc i �� <br />—�ar- <br />Uinnn InuellrJ _ _ _ (?Ilieneral I�acilnie+conneaioncharpe S_'T" � _ <br />Chsinci InsulleJ Putwe _ I71111he: f <br />-.i:.:�T� <br />�ntol emoum rtca��cd wnh epp6uluxi S____ <br />I'I IS UNUl�.RS II1�. �I � �hu this Apphcauan. ahhough sipned. sheil nm M1c h�ndmg upnn �he MUKILTF:O N'ATCR DIS'I'RIC'f umil eppmeed h� tl UI`.' I: <br />�'fit f) <br />I, Ihc undersipned nxmer 1��� repiesemavve i at Ihe propen� descnhed ebnrc du herehp meke epphceuon fm msmllnurm o(e '/�_ -inch dieme�er weier wpPl�. <br />sen•mc cnnncamn. mclndinp nppune�Wicfe und pll neceeceq ,nh��! m� erMnses <br />Unled Ilus � Jm n1 . '� ' � <br />_ ?-,---j ; <br />nrr� ir�Nrs sia!�niuiei ��,: � /1=' �— <br />_ _ _ _ -- - - �- <br />^�I�IIIC.NI�! Vd111C1�ICAtC�1l1011 I �. . � �. � _ � —."�/� �—�----- <br />r���v - e ���:� <br />..,,.,, ..� � . ._ . <br />....� _ .__—___ _. .__ _____. _— __ ____— � _ <br />App6cml'r. Addres. & Phm c Number __ __ _—__.__ _—_ -� � ' ___ _ _ " ✓� �. �• .1 • � �� : I . . � . . <br />x <br />l'N� �cs t-� M"JI4 Ili �'. t't IhTK�ll tilR.1MAF;1' AStilf$SMFN� BACF:PLON' RF.QUIRFII" __r �� __. NO ��� ��' <br />!�pcniUr�ic; _.___ ._____ tivcofikvice.__.___ Cl�Siniuels_ "�- Uele /G' � <br />_ ;� __ <br />AI'PHOt�G��11'�II'PEII N Al'1'H DISI�RI('1 ^/ <br />'' / �- <br />11�, �-i �f ��. Iiaic i�G/%0.7� I;wed M <br />