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Applicalion No. �/ � -__ . ..
<br />Ideler Size _ �1Y. " ---_--
<br />MUKILTEO WATER �ISTRICT
<br />SNOHOMISH COUNT'f WASHINGTQN
<br />APPLICATION FOR WATER
<br />Number of Uni�s � I I D
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<br />No. %� � �/ — �l'
<br />AccountNo. � ''�'— /7i�/'�-`� J
<br />i hereby apply lor water service and agree ro be governed in accordance with the resolutions, rules and regulations of ihe
<br />MUKILTEO WATER DISTRICT pertaining lo water service, now or hereattc�r in elfecL The undersigned as owner or
<br />representative of the herein described premisec hereby agrees as lollows:
<br />; t � Thnt Ihe cos! o: nny exltmsion ol the watar Eorvite, ronuWai, �eplatement ar ropeir �o roech efrd sArvo �he properry tlescnbed ahell 6C 6orne
<br />by mysoll or ossigns os ownm (s) ol thn p�emi6os
<br />(2) Thnt all p�pos, water meesuring doWcos end other �onnocunp oQuipmnnt uostronm hort M�e motei sholl, ehor their instellebon, be and 6ewma
<br />thc p�oparty of the MUKILiEO WATER DISTRICT, subjed lo ell Ils ropulouons portalninp lo weim sorviea
<br />�3� Thnt n}Inr instnllntion, if mater or mntar bor xnd eppurtnncos nre buriod or domepcd, lho owner, will Ee hold rosponsible and charpatl lo• name
<br />Ia;� That Ihe MUKILTFO WATEii DISTRICT, ds aHicors end egonts, shall hnve Iho ngM of inp�oss end egross to go upon tho pramisas and properry
<br />uoscribud hmain fo� Ihe purposa ol inspoC;on, eonnecling m diuonnecUng tho sorvico o� lor euch olhm pur0osos es tho servlcc mpy reqwre
<br />L Is nlsa undnrstood during thn time thet ert� nl Iha water mems mey be oul uf eerwce by renson ol eny omerpen .ry oi improvemants nulhonzotl
<br />h the IST IC �n n r r �
<br />y D R T, i e y st cet o otho locanon m which they mey haw hoon laiq ttie DISTRiGT will not be roquirod to fumish waler durmp
<br />Ino p�oprass uf nuch improvemontr lo nny mnsumer whoee eupply mey Ihuc bo cul oH, or be lieblo for any demapos far Ila lailure lo do eo.
<br />f5� Tm� tho DISTHICT shptl hn�ro thc nghl Io chnngo thc raros et eny timo by Resolution, to tempwanly discantinuc the sarvico to consumn�s, end
<br />tc rostaf Ihr. motm (s� to rogistor the wnter consumed The DISTRIGT she�l nol 6o hold 1ie610 lor damepa 6y water v other causo resulting Irom
<br />dnlncPvo plum6ing or apphancos inswllod by tho ownor or ocapnm on tho pramises suppliod wrth wnto�, and tho tact Ihet epeNs al tho DISTRI CT
<br />may hnvc inspoctod thc plumhinp end applinnces 6hnll not M ploed es e hesis lor racovory in cAso of domoge ex eloresAid if tha supply ol
<br />wnier shnli Inil or ha inlnnuptr.d hy mnson o! neddont, low pressure or othor eauso whntsoovar, the DISTRICT ehnll not be hold lieble lor dnn�agos
<br />no� shol! such IaiWrc or imcrruphon lor eny ionsonnblo umc bo held lo cons6lulc a 6rench of conlract an thc pnn of the DISTRICT or in eny way
<br />��raLove iho eonsumer, whotho� tonnnt o� ownm, irom poAorming thn obligelion ol euch tnnnn[s or owner's eontrect. Weter shell ba usad �y
<br />� licnnt only on Me premisos nescrihoA homm. A iew eppliceuon shnll Or. �ilod should wemr be dosirod fo� other promisos alihnupn Iweled
<br />i on IanA dascrihod heroin
<br />�� �I(6) jMet Ihe DISTAICT roeommenAs Inelellollon ol a p•enuro repuleling velve. Applicent ocknowledge� Intormellon e� to ihe
<br />,�!� rpcomm e�lon end e�sumee lul: responslblilty Icr Imtelfinp or Iallinp to Imtell e p�e�sure �epuletfnp vel��� on Ihe wsie� �y��sm to
<br />,�(iret 11 Irom Mgh prefeu�a.
<br />y ��7� Thr �ISTRICT utlllze� chxk valve� at Ihe meler Io prevont weter relurning to tha Dl�tricls m�lns. The DISTRICT rocommends
<br />�! � In�lellellrnolelhermuleYpendonlenkloprsvenlexceedvepra��u�ebulld-upuu�edbylhew�larheeter. Applleem��cknowlsdpe�
<br />Infnrm�llon �� lo Iha raeommendellon end ���ume� lull ra�pon�lbllly lor In�1�Ilinp or lelllnn tc In�t�ll � Iherm�l eYp�nalan tank.
<br />�q / �
<br />.�.� ���'ICE ADpF'cSS .l'(_�-�� /i (._ -�' _t -_'`�_; LOT NO '� ELOCK
<br />r'�TV/S?ATE/ZIP. - � �' ' � 1.,. N • � � o' ( `{
<br />:;l"JNER'S NAME- t� ��ri. �;: %'N f I �'1
<br />OWIJER'S ADDRESS. -�`� � I'�^ I/,� i+r fti. k I= JL
<br />:;iir75TATE2IP. L.. ✓' ,�' l�l (.f.%/� l� C'%i :' "'�- i y
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<br />Tnc pmmisos nro to bo used ns e __- "- :_ � �' . ,. � �� ��
<br />PLAT NAME I�/; ,%/y� ' "/1 G 7 C'i� T---
<br />LEGAL UESCRIPTION.
<br />_ i�. t �' 7 S
<br />INFORMATION LETTER�GAVE/SEN7
<br />CHARGES- n�A 7�
<br />�7-�.' . U �i FL�aai
<br />(11 Service ,nsln:lauon d wnnechon ehorpo S —_
<br />/ Sy� 2 7 2000
<br />('i Gnnornl Pe: ilitms connoclion chnrgo s DEC
<br />I�1 Olher S __
<br />Totai amoun� recervtid wrth epphcaUon S
<br />/ 7: i. U J MUKILTEO WATER DISTRICT
<br />. r, u^!DE pti7,�J;� thni 1hc Appi�� �nion. althouph t 7neC, shell not ba bmdnp u�on Iho MUKILTEO WATER DISTRICT unti'� epprovedby the DISTRICT.
<br />' r�r undrrsipned, ownar (o� reprosonLihwl a��f,,t�he 'pperty [le6cribod Bbovo, do heroby meke eophmhon lar �n,lallolwn o� e ' _-inch
<br />cf.amotor WB�Br eUpplv,tervice c�npoe�R"A^ g a�ounynenws, antl all qocgsbajy iebor a� my ezpenses
<br />D:tledlhis z' T dm-cr .� `t'�r���� 1• , !�_ . ��_�-� ----
<br />APPLICANTS
<br />Appl�,conPs Nnme (plea6e Orint) --`
<br />Appi:.anf� AAdress pnd Phonc NumDor
<br />APPROVED:
<br />MUKILTECJ WATER DISTRICT
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