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1 MUKII:tF.O WATF:N DItiTRICT <br />APPI.ICATION FOH WAT'ER <br />M1ictcr tivc� , ticrvicc Addretis: '�"� � i : � � .��� ���; � ,' �;>. <br />Numbcr nf lhiils . . . . <br />'vfctcr will bc uscA for (check all Ihm npplY)' �' Uomc4tic __-_ - Irti@ation <br />r' / Acct No.: .- I� �- 1 <br />. _ . Fire Service _ _ _ Pire I.ine <br />I hcreUy npply li�r we�er service nnd nprec tu he govemed, in ucmrJnnce with Ihe resulutinns, mlcs nnd regidnlinns of ihe MURII:I7[(1 N'A'l l'.It <br />I�Iti I121C-I� (M WI)) pennininti In �cmer scrvice, nmv or herrn�er in e(lici 'I�he undersiEned ns m�ner or represenlmi�e of Ihe herein-JescnM1eJ <br />pirnmcs hcrcby ngrccs as �i�lluus�. <br />� I I !he cnnsumer eFmoc In uulnll, nperxk miA mnnuum nt �JI umc., Ihch plumhmE x7rlrm m cnmpGnntt wilh tlm cunent edi�inn nflhe Ilndorm Piumhinp <br />CaJc ds it pcnnm+ In Ihc prrccmum af cnnlnmineunn. nnA pruicc�mn (rnm Ihaimnl c�pnminn Juc lu n dnsed syslcm Ihnt could iKcur wilh Ihc pres<nt ar <br />lulure inslellnlinn nf hiicAllaw prevcnm�. nn 11¢ cumumci'� srrvicc nnJ/or n1 plumhmg fixtures <br />I: i "fhe cnnsumer nErtn 1�� wslnll nll hncAllux prn�enunn ncttmhhes requeslyd hy Ihe MW'I ), nnJ In nrnnlain Ihou hacAllnx prevention essemhi¢s m g�mJ <br />wnrkinF urAcr llic n�,cmhhcr xhxil hc o! e lype, snc nnJ meke npprureJ L� ihe M\4'U nnd Ihc \Vnrhinglnn Sla�e Ikponmenl nl I Ieahh AulhnrilV 7 hc <br />nsscmhLcs shiJl hc manllcA m nccmJnntt with ell slenAurds eslnhhshed hy Ihc M14D � <br />i� i 'Ihc Hmrr meter wdl no� bc roslxlkL unlil e wemr uu xurvcv hm M1ecn auhmiueA 6� Iho npphcnnl nnJ Ihe Uiqrich Crrns ('nnnccGnn ('nmrol Spe<ixhsl hes <br />dacnumcA d Ihc cuqnmcr wlll nccJ In mstell e Fncklluw prcventcr un Ilm uiqnm<rt siAr ul Ihr mcirr <br />i4 i '(hnl Ihe cusi nl nnv crlrnciun ul ILe xnlcr ettvice. rcne�wd. rcphicamrnl ui repmr In �each nnJ ,en'c Ihe pn�penY AcscnheJ shell he M1nme F� nryself u� <br />nsvlym ns ��wncr(sl nf Il.c prenu�c� <br />I`� i lhnl nll p�pex. wak� menwnnF Aevice� nnJ ulher conneeuim eqwpmenl upstrcnm (mm Ihe r ieter �hnll. xller Iheu mslnllnW m. hr enJ M1ernm. Ihe prnpeny n! <br />Ihc All1'I ). suh�ecl In nll m rrgu6nwn. pnlainmti �n ��xtu scrvkc <br />1�� i I h,n nllcr mmJlnnnn, il mcler nr n¢let buv anJ eppunenelrces erc FuneJ �K JmnngcJ, lhr uener. e ill he hdA �esponsible nnJ cheipeJ !ur seme <br />i 7 i 1 lial Ihc MN'U, il. u0icrrs nnd xEcnls, shxll have Ihc nglu nf mgrc�s end cpr<ss In pn uron Ihc prcmisrs xnd prapeny descrihcJ hncm fnr Iha purp�sc af <br />w,pccuon. wnncclmg nr iGunmrcclm f Ihc scrvire m fur +uch athri purpovrx ns Ihr •:rvicc mn� rcyuue I� is elsn unAcwUHid Aunng Ihc lima Ihnt eny of <br />ihc ��etct nmiro mn� hc mn nl serviec Ip� rcnsun nl my emcrpcnry ur unpwrcmr•.a mnhanird b� Ihc MN�I), 111 fllll'tlfCfl O! 011lfl Lk'fllllrp 11111I11.. Jlf)' <br />m:�> ha�e Aern hud. Ihe MN'U �aill n��i he i�•�purcA lo funuxh ��aler dunnp Ib. prnE�ies� ul +u�h improctntcnk lu en� ennxmnn whou supplp nm� Ihu� he <br />cul �dl. a� hc Imhle lin nnt JanmFre Im its fndurc In Jn w <br />�N 1 I hnl lhr MN'11 sh:dl hm-e Ihe nFhnu chnnEr Ihe fnle� ol nnq Inne F� �trsnlulion lu lempnnmly dnconGnue Ihe sen�mc lu cunsunien, nnJ lu mAnll Ihr <br />i,mlrq�l l�� reEulci Ihc wnia cuneumcJ 'I Lc 1.1 WU xhnll nnl h. held hnhlr fm A:unnEe hy �rnler or olher eauva rcsuhm4 �ium Adeclnt phnnhrng or <br />;�pph:in.cs inanllcA hy Ihc mrntt ur nccupmm �n Ihc prcm�•..s mipphcs with �rnlcL nnJ IP.c ind Ihnt nqens nf Ihc MN'U muc hnrc in�pccicd Ihc plumbin�• <br />;md npphunce� shnll nut hc pla�J n� .i Fn.0 fnr rccmrn m cna nl Amnngc rt� xlirtnn�A if ihc supply nf waln shnll ISiI nn c� imcrniplrJ h� rcnvun nl <br />a.aJcnl. lox pieti+ua in olhn om+c elunsiavn. �h• A1WU �hxll nnl hn c�ld hnhle (ur damapes n��r sholl wAi ladurc nr mlempb��n fui nny rtx�nnublr iii��r <br />I�c hrlJ lu cnn�utnic n hrcadi ul mnuad on Ihv p'.rl nllhc MW'f l nr m m�y wii� relicar Ihc cunmm<r. xhrlhe Irnx�n nr owner. Gom pafurmm�! ilic <br />uhhg:tlu�u ul wch ivn�euY+ m m�nrr�� i�unlrnci 0.'mei shnll Ix u=ed In apphcnnt onl� nn Ihc �n;mues AeseriheJ heidn A nea oppl¢nunn shall he IJ� t <br />.6�ndJ wnin h� Ar.nrd I��: mhei inenuw� nlihouph IncaieJ un IanJ Je.enbeJ hercm <br />pq l lrnl Ibr �I\t U irrnmmrnM in.tudotlun nf e pre�mn regnlutinC rah�r. .Applinnl �rknnwtrd�;rr Infnrm�tlon u In Ihe rtrommend�tlnn xml <br />n��umrr lull rtymndblliH fnr itnlpllinG nr fullln�; to Inet�ll a prrewvr «pul+tlng valvr un Ihe w�lrr �yelem In prolert 11 frnm hlRh <br />pn•suu-r. " I\l. <br />( III� 1 hr �I��ll itlllvn ditrk �phr+ �I lhr melrr In prtrrnt walrr rrinrninC lu Ihe Ili.lricl� m�lm. �fhr 111�1'l/ rernmmende Insul411un nf a IA�rnud <br />npnndnn I�nM In prr��nt nm�i�� pr�ww r build-up rnu.rd Iy Ihr �ukr h�alri. Applic�nl �eYnnwleARee Infnrmulnn ei In Ihe rrcnmmeniL�.mn <br />uid pruunr�lull rnponxi6iL1) fur Inrbdling nr fnilin4 In in�Inll a Ihtrnul r�puulnn I�nk. , !�:' �N7�. <br />til IfCll I -111UR1 SS . .. � � . . � I111 NII � � IiI/K'A <br />. , � ' .. - _.. . <br />l'll l'iSlAll�//IP. � . -7 . .. . . I" 1 � N�A11� � � ' �— <br />uN'Nfit:tiNAMI ''r�r(n i�./��� � ^����� �' . '__ IbiAI Ulti�'RII'IIUN � ��'_ '_�'��� �_. <br />u\\'Nlli'tiAUIlRitti . � 7j' �-'.�.% . <br />l'_� .. �_.f_ µs. <br />i II1"tilA'I'Gr/IP .. .-'� ��� "�� � IIIJI(il'I'HMII IStillfl)8ti'- � �i <br />I�.,:pinnrsccerclnh:uxrAmn __ �'��"_' _ . . . . INFUItAIAII(INI.I.:llli^riIVCN: � .. <br />�,� r.��u'1�.7�'I'f (_'lIAN(iI��S. /�J <br />I�� .. L�pi�i Insmllcd L�� 111 �en ice inslnllminn k ennn•clian cherge S. ._ __��771 �.. <br />I�o-.iii,ilnclnllcA �2�(irnrmll�nciliucscnnncctinnchmgr S _'"�_���•'" <br />Ih�.inr�InatnlleJb�tlure I1�(llher t . . <br />- ,�� � <br />I innl nmuunl iacerccJ enh apphcnbun S ��'"i =. , <br />I I Iti I iNI�PKSI� N ll l lhai �hi� App6ceunn. nl�huugh signed. xhnll nnl hc FindmE o�m Ihc MUA11:17iU R'Al1fR I)ISIRIC"I� unld apprnvcd b� ihr I Ht I RU 1 <br />I. Ihc undrislFned uwnei �o� rapiccemnlrvel �d Ihc pnMey� dnruheJ uAnvr. Ja hereh� mnAa epphention !or mslellauon of n. /_�mch Jieme�e� xaic mppl� <br />�e�i�r i'mmttlipn, induding xppuhrnAncrs, NnA nll ncn��.nq I.�,,m nl my crprnsa � <br />Unlvd Ilu. � d;n ul ' . <br />4i'I'I It'ANfti'tiIt:4AlU111 � i <br />Apphcnm's Nnmr 11'Icnec pnnll <br />�lpphcnnt's AdAitss K I'hnnr Numbt� <br />/ <br />�.i �� . . '�,.� <br />. .� ,:. -:/ : ,y% �1�;�,�`i� <br />S'R�ttitii'nN4Pt'IIUNI'�)N7Ht11 SI��IAIAHI'AStii3tiA11N11�ACAli(�\CRI'VUIRPDP /YES X NO`�// <br />I�pcnlltcucr tiiioullkcitt CCtilnilide Z•i�ele. �-f ��_% <br />_f—�— 7 - r <br />AI'I'HII\711; �'111'All IEON�ATEltltltilltlll `/� / <br />II� . . ' l. . Unir `�/�" �� _ k.ueJH� <br />