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♦�•p.�.�.�,.s � . , . • .. . . .��.�•a , � . , . . . . . . . . � <br />Application No. <br />Me�er Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Number ol Units <br />No. <br />Account No. <br />I hereby apply (or water sQrvice and agree to be governed (n accordance with the resolutfons, rules and gulQtions of Iho � <br />MUKILTEO WATER DISTRICT perldining to water service, now or herealter In o11ecL �The unde ned as owr�er or� <br />representative ol the herein•described premises he��eby agrees as lollows: , ' / �' <br />�t 'r <br />( I) Thul Iho cost ol nny oMtnnsion ol Ihn wntor sarvico, i enowol, rapWcament or �oFoir to reach and s���vo tho pro rry des:ri6od tihall 6o bomo � <br />by mysell or nssigns ns ownnr (s) ol lho pramisaa. - / <br />(2) That all pipos, walcr mansuring dovicoe end alhor wniActinp oqulpment upslroom Irom tho motor shaii, oh thoir In:;IntlriJion, 9e and Iwcom9 �'- <br />Iho proparry ol Iho MUKILTEO WATER DISTRICT, subjod lo ail ite m,ulatlons porteininp lo wator sorvi . r�� <br />(3) That ohr.r inslnllalion, il motar or moror box anA eppurlonwe aro buriod or domapod, Iho avnor, will bo rrsponsih n end r,hnrgod for eomo. <br />(4) ThanhoMUKILTEOWATEFiDISTRICT,i�aollicersendegontt,challhnvolhariphtofinpresoendop slogoupontlwpmmisasendproparly <br />doeaibod horoin lor tbo purposo ol inspoclion, eonnactinp or dseonnacdny Iho servico or Im euch Ur purposos o! Iho sarvico mny roquiro. <br />it is aleo undorstood cluring the timo thal eny ol tl�o weler mein� mey De outol eervice by reason ol ny omarg �ncy or , npravements nulhorized <br />hy tho DISTRICl, in eny strool o� otho� bcation in whkh they moy have haon laid, tho DISTR T will not bo mquirod lo lurnish wator durinp <br />tha propross ol such Improwmonte lo any consumer wMse eupply mey Ihua be aut ofl, or iieblo far nny dnm�gos fo� its Iailuro to do so. <br />(5) Thnt Iha DISTRICT shnll how tho right to chanpo M+o ralo� al any lime hy Rosolutlon, lo to ororily disconUnua tho snrvico to coneumcrs, and <br />to Inslnll tho mota� (s) lo rogistor tho wolar eo�sumed. Tha DISTRICT eholl not bo hold lia o lo�damape by watororP.hor eauso rosulting Irom <br />doloclivoplumbingornppliancosinsmllodbymoownororoccupantonlhop�omiseecupp' wilhwator,endlholaalhqtoponlsolthoDISTRICT <br />� may hnvo inRpoctod Iho plumbinp end nppliancoe shnll nol be plcad at e 6eelt lor ro vory In ceso of dnm:�go es alorosaid. If Ihe supply ol <br />wnlershalllailorbointorruplodbyreasanolnccidant,lowprossureorolhorcnusowh soowr,IheDISTRICTehollnotbeheldlieblofordamaget <br />nor shnli such Iniluio or in�erruplion lor onyioasqneble Gmu bo held to consti�uta n eoch ol contract on Iho part ol iP�o DIStRIC7 or in any wny <br />' ruliavo iho Fbnsumar wholhor lonenl or ownor! Irom porlorminy Ihe obtipetion euch tonanfs or ownafs conlract. Wetor shnll bo usad by <br />applicant onlµon tM"�,romisos dasuibnd horoin. A now apptication shell bo li d ehould wator be dosirod lor othoi promisoe elihouph loealed <br />on land doscribad htl�oin. <br />i��r ._—__(6) Thal Ihe DISTRIOT•reoommend� In�tallellon ol � prouun rogui ng valve. Appllc�nl �oknowiadpa� lalorm�llon e� lo the <br />racommendetlon end e��ume� lull re�ponolblllly lor Inslelllnp or le np to Imlall � pre�surs repulelln� vdJ3on ths w�ier �yelem lu <br />protecl Il libm hlpj� pre�sure. <br />�Nt _.__.(7) The DISTfl(�T u111Pie� chock velve� �t tha meler to provenl w er rolurnlnp lo ths Dl�tilol� maln�. Tha OISTRICT reeommend� <br />Inelellullonnl�lharmeleKpqmlonlenktoproventa�csulvepr �urobulld-upc�us�dbylhew�txhaaler. Ap Iicent��eknowledger <br />Inlormellon �� lo Ihs reaommendslion and ���uma� lull res onalblily lor In��dllnp or lallinp 161n�1a11 � IlS�mel e�penslon i�nk.� <br />S[RVICE ADDRESS:�.Q_ <br />___ }` <br />CITY/STATFJZIP: <br />OWNER'S NAME: <br />OWN[R'S ADDRES� <br />GITY/:;TATE2IP: <br />Tha promisos nro lo ba usod ns n <br />(1) Sr.rvico <br />(2) Ganorn <br />(�) Olhar� <br />,� � <br />LOT NO. , BL�K <br />I <br />PLAT NAME: � <br />LEGAL DESCRIPTION: . . I . <br />INFOFMATION LETTER�GAVE/SENT�. <br />CNARGES: <br />6 connectioo cha�go 3 — <br />connnctiun charpo <br />� – <br />� "1 <br />Tolal�ouN roceivod wiM epplicauon S� <br />��. <br />IT 19 UNDCRSi(�D Ihnl lhis Applicntio hhouph signod, shnll nol bo 6lqding upon �ho MUKILTEO WATE <br />I, tl�n und�rsignecl, ownor (or mpmso �.) iw) ol tha property doscrihad ebovo, do homby msko epplication <br />dmmmer watur supply scrvirn eonn cUGn, includinp oppurtonencot, �nd all aoeossnry Inbor et my ecpona� <br />Datr,d this _ daY J �.19 . / <br />APPUCANT'S SIGNATUFEt <br />kpptic�nl's Numd (ploa'so piii <br />Applicanl's Addross ond Pf�6r i Numbor: <br />APPROVED: <br />MUKILTEO WATER DISTRICf .. � ! <br />oy: <br />1�., ' I �i t �-i <br />Dale: <br />1 <br />until upprovod by tho DIS?HICT. <br />ol e <br />-i� <br />