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<br />�, MUKILTEO WATER DISTRICT �: .
<br />SNOHOMISH COUNTY WASMUIGTON �[ �
<br />APPLICATION FOR WATER "J
<br />f ___—���/ ��� No. 1.i � r�i�%�—�
<br />llpplicatio� No.
<br />Meter Sizo �/ _ Number oi Units _� Account No. �'���
<br />I hereby apply for waler servfce and agree to be governed In accordance wilh ihe rosolutions, niles and regulations ol the
<br />MUKILTEO WAfER DISTRICT pertafning lo waler service, now or herealler in eflect. The undersignri,� as owner or
<br />representative ol Ihe herein-described premfses hereby agrees as follows:
<br />( t) That Iho cost of nny aztunslon ol lho wnlar sorvico, ronownl, roplacemunt or rapei� lo roech and aarvu tho p�aporty doecribod s•�alt 6o borno
<br />hy mysoll or nssigns os ownar (s) of Iho promisas.
<br />(2) That all pipos, wnter mansurinp dovicoa end athor connocting equipmant upstroam hom Ihe moto� shall, eftor thoir installatlon, bo end bocomn
<br />Iho p�opar�y ol lho MUKILTEO WATER DISTRICT� 6UD�Od �O 8II I16 fQQ11I8�1Of18 PBf18111IfIQ 10 WOIBf 60NIC0.
<br />(3) That altor instnuntion, il moter or motor box ond epputlaneoe are 6uded ordnmagad, tho ownor, will bo hold responsibto end ehergod br snmo.
<br />(4) That tho MUKICi�EO WATEF DISTRICT, its alficer� end epoNs, ehall hew Iho ripht ol ingroen and npross to po upon Ne prumisos nnd propmty
<br />doscrihod horoin lor tho purposo ol inspoction, wnrroctinp or dseonrroe6n0 Ihe eorvico a for such olhor purposos es tho sorvieo may roquiro.
<br />It le also undarslood during Iho timo that any ol tha water meine may ba out ol service by reeson ol any ome�guncy or improvoments authorimd
<br />hy �ha DISTRICT, In nny sUool or o�hor IocoNon in whkh thoy mey haw boon Iaid, Iho D)STRICT will not bo requirod to lurnish wetor during
<br />Iho progmss ol such improwmnnls lo any wncumer whoce cupply mey Ihu� ba cul oH, or bo Iia61e ior eny damagoc lor its fc!'�ro to do so.
<br />(5) 'h,t tho UISTRICT shnll hovo �o rght lo chnnpo Iho rale� et eny �ime by Roeolullon, to lompaanly disconlinue tho wrvieo to consumors, nnd
<br />ininsmlllhamomr(s) lorogislorthowalerconeumrd. ThoDISTRCTchell�olboholdlie6bfo�damnpobywolororothorcausemsultinglmm
<br />uolectivo plumbing or opplieneoe inelallnd by tho ownor oroewpen' on Iho promison suppliod wilh wemr, end tho lae: thol agonta ol tho DISTRICT
<br />ni�y linvo Inspactad Iha plumbing nnd oppliencoe ehnll nol be plovd at e bosis lor roeovory In ease ol dnmege as aloroseid. II ihe supply al
<br />wntcr shnll lail or 6n intnnuptod by rooson of accidont, low prossuro c+othercaueo whatsoowr, tha DISTRICT shnl! not bo hold 1in610 lo� damepos
<br />nor shall rtuch lailuro o� interruplion lornny roosona6b timo bo hotd o conslitute o brvach of conirect on tha pnrl ol tho DISTRICT or in eny way
<br />roliovo Ihn wnsumur, whothor tananl or ownar, Irom porlorminp ms oblipation ol such tononl'� or ownor'c corlroct. Wetor ehall bo usod b�
<br />applicant only on tho p�omisas dnsuibnd horoin. A how npplieatior ehall bo lilod should wato� 6a dosirod lar olh. r prumisos elthouph Ixaled
<br />��� ` on land doscribod horain. �
<br />v e Thel �hs UISTRICT recommend� Inslellellon ol � pre��urs regul�tlnp vetve. Appilcent xaknowledgea Inlormallon e� lo Iha
<br />�ar __( )
<br />racommendetlon end a��umas lull rasponelblllly lo� In�lalllnp ar lalling to In�lalle pra��ura ragulalinp valus on �he weler �yslem lo
<br />prolec� Il lrom hlgh pressura.
<br />iNr ____._ p) The DISTRICT utlllzo� check valvo+ ai Ihs mater lo provei; :nler roturnlnp lo tha Dblricu maln�. Tha OISTRICT roeommends
<br />Inslalletlonol�Ihermele�pen�ionlenktoprevanlesce��ivaprs��urabulld•upeau�sdbythew�tarhealer, Appllcanl��eknowtedge�
<br />Inlormeilon �� lo Ihe recommendellon end ���ums� lull re�pon�lbllly lor In�Ulllnp oyl�llinp lo In�ldl � Ihmmsl etp�n�lan lank.
<br />��� ��/ �
<br />SERV��oAQ �R`�ESS'�"L,/�'T' S�� LOTNO. n•� ,/ BLO,/CK�
<br />�Ny4G SZ)3 PLAT NAME: //�/f�/%�LL�i./ �//�Z.t/.GGI�`��
<br />C�TY:S7ATB21P:,`� t.li`4 ,Jl�� l% %� LEGALDESC/�RIPTIO : 7'o'f/�1 /%% ,/�
<br />OWN�R'SNAME: S�Gl1L�' II,/��'S /� /��,�/-�`�� S/—
<br />OWNBR'SADORESS: ���� �'��� �`' �`'�'���'?�� --
<br />CITY/STATE/ZIP: � G��, I�4• �k��
<br />Tho promisas nro lo bo usad as a -�------
<br />--_`y� � "�%�n-�>l� INFOPMATION LETIER-GAVEISENT: �� .*n
<br />CHARGES: �A+�
<br />(1) Sorvico Inslallolion 8 wnneclion cNarpo S— ���' G�
<br />ii6 q �..� NOV 171995
<br />(2) Gonornl Fncilitiot co�nocGon chargo S
<br />�3> om�� s MUKILTEO WATER DISTRICT
<br />� Total omounl roccival with epplimtion S � 3 y�' �
<br />I7 IS UNDERSTOOD thal �his Applicaiion, elthough signed, shall nol hn t+indinp upon Iho MUKILTEO WATER DISTRICT until epproved by the DISTRICT.
<br />I, Ihn undorsignod, owna� (o� roprosonlntivo) ol Iho proporty doscribad ebovo, do heroby moka applicaGon lor Inslalleqon ol e ��'� �inch
<br />dinmolcr walor su ply sorvico connaclion,�nduding nppurtonancea, and all nPcossnry la6w at my eMponsos.
<br />Dnted this _�1_._ dny ab j� ,19 ��>
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