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MUF;ILTF.A WSITER DISTRICT <br />APPLICATION FOR N'ATGR <br />Meter S¢: -' " Scrvice Address�. '� � ' � � � � <br />Number of Umts: / <br />'Meter e�ill be uscd for (check all lhat epply): v Domestic _ Irrigetion _ <br />_ Acct. No.: gQg� <br />Fire servicc n JFQ a 3! y Io <br />I herebp eppl� for wa�er service nnd eErcc tn he govemed, in eccnrdence wilh the rcsolulions, rulcs and rcgule�inns o(ihe MUI:II.TE'.O 0.'Ai'f�:R <br />DIS7RICT (MWD� pennming lo w•eter servicc, nnw or herwfter in eRaL The undersigned dt owner or rcprcsentetive of Ihe hercin-describcd <br />premises hereh�� eprees at lidlnws�. <br />( I 1 The consumer eprees U� mslxlL openm enA mem�em et dl umes,lhev plumbmg syslem in enmplmnce wllh Ihe curtent edrtion o(the I Imfortn PlumhmF <br />Code es ¢ pmems In Ihr prevrnuan nf cnntwnmeuon, md proiccUan frnm Ihertnel eMpmslan due lu e clmed system thet cauld xnn wnh Ihe pmsrnt nr <br />�OWI[ IOS�GIIEII011 O(II�CYOON �IfCV[pIClSllfl �IIC COp511111R�5 9lNlCt EOd'nr ni plumbmg flzturcs <br />1'-1 lhe consumc� egrees u� mstell ell hecAll��w prcvenUon tasemhims reques�ed hy Ihe MN'D, end Im m�minm Ihose bock0ox� prevrnt�on usembhrs m gorrd <br />wnrAmg order The enemhlin shnll he o( p npc, svic end mekr eppm�ad M lhe M11'f I end lhe Wnshmgton SWe DepenmeN of Heallh Authonq '!hc <br />nssrmhhes shdl br mslnikd m eccnrdmec wilh ell xtenderds esieb�ished bc ihe MN'D <br />1? I The weler mcler will nm be ninalled unlil n water usc surver hes heen mbmmed hp lhe epphunt end Ihe Drstncls Cmfs Cnnnrcuon Control Spenehst hn� <br />detemuned if Ihr cuslnmci xill nerA �n mvtall e hackllou prcvrnler rn,1he cus�mmer's eido n(the mcler <br />i4 i That Ihc ensi nf enr ecicnsinn of Ihr wemr sen�¢e, renewnl, replecement or repnir in re�ch and scrve Ihe pmperty descrihed shell be Irome M� myself m <br />nsvpn� is nwnensl of Ihe prcmisn <br />!Sl Thet ell pipes, weter meavurmF dev¢<s enJ ntlrc� connecunn eqwpment upstreem from �hc meter shell. eller Ihar mstelleuon, he end becnme Ihe propem ol <br />lhr �1WU, wh�ect to ell ns reFule�inns peneimnE m wakr sen�mc <br />IGI '(het u(ier mslellsuon, if inemr nr mner bos end eppuncnmre� nrc huncd nr dnmeFcd, �hr nwncr, wlll hr helJ « sponvblc end chnrged fnr seme <br />171 lhat Ihc MWU, ds off¢crz end eQents. shnll horc Ihc nght nf mp¢s� nnA cgres� In gn upnn Iha prcmrses enJ ptopertc descrihed hc¢m for tlm pmpnu nf <br />mspe;unn, ennnecline or disconnecung Ihe servme nr (m such mher purpnves nv Ihe scrvice mn� rcymrc It is elsn undnstwd dunng 1he I�me lhel em� nf <br />Ihr Hnlrr mams mny be out n( serv¢e h� �eacon n( em� emergrnry nr impmvements eNhmved hy Ihe MWU, in ony slrcet or olher Inca�inn m which tha� <br />mm� hm�c been loid. Ihe MWU will nnt br rcymrzd �n fum¢h wnler dunnp tl�c proFress nf such improvemenlc in en� ennsumer whose supplr ma� Ihus hc <br />cm oa ��� n� i�ani� fur em Jnmeges fm iL� (nilurt �u Ao sn <br />IN i 'Ihnt Ihc MN'U shnll hevc Ihc nphllu chenFc Ihc mta el em umr hy Itesnlmmn,lu Icmpmm�k discnnunue thr serv¢c In eoneumcrx, end In mslull ihc <br />�ne�e�sl In�eFnler thc aniei cnnsumed The MN'U shell not hc helA hehle fnr dnmoFe Ay weter nr o�her ceuse msWung Gom defecuve plumhm� or <br />enp�unclGmctollcA ht Ihc nWmcr nr occupnm on Ihc prcmises s�yqnc�s with weter. anJ Ihc lact Ihet epenu nf O�c MU'U mn�v! jn}FgcleJ Ihc plumbinE� <br />nnd apphnnca shell nm bc pleed u n bmis tnr rccnven m cace o(dRnApext dnresaid if the suppla o( weler shell feil or Irc'hilerfLplW by rtasnn nf <br />e:ndrnt. Inw� przssurc nr nlher ceuse w�hels<xvv, Ihe MWU shell nnt hc hcld ImFle (ar Jmm�ers nnr shall such faJurt nr mirnuplron for eny rtssonnhlc umc <br />h;,beliLlu.amelnute n b2ech a(cnntract on Ih: pert of Ihe MN'U m m vir way rchere Ihe consumu, whclher tenent or nune�;`Hum performmg lhc <br />oMiFeuon af su:h IenanY. or ��wner's mmract. N'eter shall be us:d M eppl¢en1 nnh on Ihr prtmisa descrit�ed he�nn A new epplmeunn shnll hc f➢ed <br />�hnWA xntc,� h��i�c�rcd lor ulhrr premun nllhaueh I��ce1cJ nn lund dcscnheA hc¢m <br />I�I 7�h���IN'll rrcnmmrnds Imullsllnn nf� prnn�vr rrF���alinp vdve �ppGr�m �rAnnwlydRn {nfarmUlnn �x In Ihe rrtnmmend�tlnn �nd <br />axum<� full rexpnnelMllty fnr Immlling nr f�ilinC ��� ������I � prrnenrc reFulnmF r�h�e un Iht wHer fy�tem tn prmett il fmm hi�h <br />prcsmrti �- � INI. <br />(101 Ihr !11N'1� �nlliirs rherk vuh�r� u Ihr mrirr In prrrem wu�er rnnrnln{; la Ihr bl�lrich m�in+. l'ha \t\5'll rrenmmends Imldl�linn nf � IA�rmal <br />Ytppminn IanA lo prcvcnl rtrct�irr prnwrr Inilld-np cnuuJ h) Ihr wuer hrurr. Applic�m �rkhnhlyd4r� infnrmuion �� In Ihr rrcammrndatinu <br />�nJ wumn lull rr�poulbHin fnr In�ullin�; nr (ailm,�, ia inndl a lhrrmd eip�neian unk- I�' I�'1�. <br />SI�:I;b9f'I .Allhiti'tiS � �' � �. .." �/' ' '. � � �. _ . 10'fN0 �% IiI.U:'f� <br />l'IiSYtifAT7_21P � — � "' <br />ON'NER'tiNAMfi—_'___—_ --. ^ ___..____,-,,.; i_ __.. <br />OWNER'SADDNCSS�.=�S�.��J ��/�"- �' ���� <br />CI-fl"SiAT1:21P _ � `� '�'�., � —_ <br />lfic premues m la M1e used aa <br />SI:13Y1S:E:IYL'f _ <br />Ikveloper Inctnllad _✓_____ <br />U�slrml Insiellcd _ __ __ <br />Disln<� InstelleJ Fumrc <br />PI.AT NAME _�'�i � <br />LF:CiAL UI:tiCRIPTION. .�"= �` �!�: <br />f11.U(i PGRMI'f ISSUED li}''— -- ' � <br />INfJRMA'IIONLE'ITIiHCIVf?N / <br />C119[iSi[;ti. <br />� <br />(1) Servicr msto�lnlinn 3 cnnncmian chugc S_ �.?J• �. <br />1:1(icncrel I�ecihuc. ccmnccuon charpc S_'�� _'.%� � <br />131 Ulha f <br />--__,i_i <br />lotel emoum reuived wnh epphceuan f.�'�'"__. <br />Il Iti UNUERST(K)U thei tlus Apphcetmn, el�hnugh sipmd Sheil nnt hc hindmg u�n tho MUI:IISf:O N'A7FfR DISTTtICT umil eppmred h� Ihfj)1Si ki'I <br />t-11 U <br />L �hr w�Jersigned ��wner lor repmenteuvel af the prupeny deccrihed eFeno. du herehy make epp6catmn (nr msullehnn o(e "���' •mch diuneter wnm� suppl> <br />���rcice cannecunn. mcludmg eppunerenns, end ell neca��n Jn�+qu: m� eapenses N �I,� [� �i- <br />I�amA ihis _ �.L_ Jn� nf ___ _�_1. ',�_ � U 2 n��'1 <br />.. / <br />,rri icnn�rs'si��Nni�vei�. -- =h� � ^� --- ------ MUl�ILTEO YrA.T�R D;; J�,:;,I <br />4pphcxnl'�Nunr�pleuscpnn4 __J`'� f�� I: r. v_' _ <br />npphcani's Addras A Phonc NumAer -I�" ' ( ' ' l � �, ' . - ,•,.I • • � . . t �, a, - •� � <br />('NntitiCciNNFCiI(1NCi1NTlt01 tiUMMAR1�AStiPtiSMf4'TRACKFLON'RCQUINf;D^ -�y lE5 X NO / � <br />'f�prnllk�ix __.___. tiircnl'Ihs¢e CCSlnhiels- C.� Dele. 7�n/ �� <br />nrreovi ✓' MI'611.TF:(1 N ATF.R PIS'I HI('i --_ _- <br />��i - <br />H� <br />� <br />i <br />� / �� <br />nam 3 f�; � 'z' y <br />,' y___— _-- <br />Issued Ay�� � <br />