Laserfiche WebLink
MUKILTF.11 WATF.R DISTRICT <br />APPIJCATION FOR WATER <br />�- � ' � - �l L `"( <br />Metci tii,c: � ticrvice Address: I�. .�, f i �-.� Acci. No.: `� <br />Nwnbcruflhiits: i � . . � <br />Mcicr will be uscd 1'or (checA nll Ihat apply): ._ I�� . Domestic ____ Irtigetion __ ._,_ �ire Scrvice Fire I.ine <br />I herchy npply fur wuter service nnJ upree lo he governeJ, in accorJanee ui�h �he raalutinns, mles nnA rcguhuinns nf ihe MUKII.TIiO WA"fPlt <br />I)Itilltl(' f IMN'111 perinining �n water scrvice, now nr hercefler in eRect. 'Ihe �mJersigneJ as nwner or �epre.:en�nt�ve ol the herein-described <br />prcmiscs hcrchp np�rec nti fullo�cs�, <br />1 I I Th� rnn�umer nprtcti u� mslnll, npemlc anJ mnimain nt all limcc, lhcir plumbm{! sysrcm m cnmplientt wilh Ihe amcm eAib-m uf Ihc I lni(arm 1'lumbmg <br />(ldc n+ il perinins lu Ihe prn�enlinn nf cnnlnmmnuon, end prnleclinn from Ihenunl rvpnnsinn du< lo o closeJ syskm thni cnuld �Kcur wilh Ihe ryresen� or <br />lulum mclnllauon of bnckllow prcvemers nn the consumei's service nnd/or et plumhmg fivlures <br />RI �fhe consumer aprms In iminll pll hnck0ow prerenuan essanM1Gas myuesmA b} Ihe MN'U, end In meimein lhese AockOnx prcvenlion msemblms in grk�d <br />warkinK �rtJcr 'Ihe nasemhlics shnll M1c ol n typc, sve nnd mekc apprnvcd h�, Ihc MN'f l enJ �hc 1Vdrhing�nn S�ale Ihpenmenl of Heellh Anlhonly lhe <br />msembGcs shell he insla�lcd m nccurJnmr wnh ell slenAeids rsmhGshcJ hy Ihc MWU <br />1 i 1 "fhe wnmr me�er e�ill nn1 M ma�alleA umd a wnier uce survey hwe heen suhmmed hp Ih< epphcenl end Ih< Uislrias ['ru�s CnnnecUnn Conlrol tipeciaBsl hus <br />AclennineJ itihc arc�nmm will nacd In insiall e hm�klluu picvenmi nn Ihe cu�lonmr's sWe of Ihe mcler. <br />ph �I'hui tl�c cust nf mry' eslrntiun n! Ihe �rnlcr xrvme. rrnewul, repixcanenl nr repnn la rench end xerve Ihc pmpert} descdbeJ shell be Fnma hy myself nr <br />auiEnv eY uwneqs) ��f Ihe prcmue� <br />1'1 l luu �dl pipcs. w��nei meiuwmf Aevia:s xnJ ulhri connactinn vympmrm upslrcnm Gom Ihe metei shell, eller Iheu InslellaUnn. he �nJ hca�me Ihe propcny ol <br />�he MN'U. sub�ce� �o nll n� reEidmums prnnininc lo wnlcr senaec <br />1�� i I h:e nl�ar inslnlleuun, il meiei oi m<kr Fm nnd oppunenmmc+ nrt FuneJ rn Jmm�@eel. Ihc nwnei, wdl he helJ rtsponsihlc nnd divgeJ lin samr <br />i 7� I liai Ihc MW D, ils o@cns end nFcNs. shnll here Ihc nghl n� mgrtss and ep¢ss to go u�m Ihe prcmises nnd pruperry AexcnbcA hrrtm fui Ihe pwpn�c uf <br />m�peclinn. cnnnecting a� iLsconnecUng Ihe servicr nr lur sucL olha pu�v��rs ac Ihe ttrvice mnc r<qwrt h k nkn imArrsliwd dunnK the Om< tlml miy nl <br />thr �r,uei m�wi. innc he n�n nf survicc h� rcn:on ul eny emergency nr mipiarnnems n�nhnmed hr Ihe MN'D. in uy� slreel or alhai Incounn In whml� Ihey <br />ma� hmc hirn IniJ, Om MN'U ��ill nul bc rcquired lu Ihmidi wntci during Ihc pmEress nl such unprnccmcmc lu nny conuunei whnsc supply may Ihus Fc <br />cul oll. ni hc Imhlc lui mry� Amm�Fcs lirt fls (nilure In dn sn <br />�%i Ilial Ihc MN'I� shnll hnrc Ihr �iFhnu chmiec Ihc rnlrs nl nny Inn<hy HcsoluGnn.lu Irmryrtenl4 �h�cnNmuc Ihc scn�icc In cnnsumtts, ond In m.txll Inc <br />mrleq � 1 lu �ckiNc� Ihc xnlri enmunicA I h< A1lVU slmll nut hv hAJ hnblc fnr Jmm�ge hy anlci a� alhcr ea;ne msuhmg fium AefrcUvc plumhing m <br />npplimses mstalleJ M� Ihe ownci m nccupnm an Ihr pmmi�rs >uppGes wtlh wnlrr. end Ihe incl llmi ngems of the M WU mny hme �nvprc�eJ Ihr piumhing <br />nn�l npplumccs sLnll nul he plcnd n� a h:wn li�r rccu�cn in cnu nl�damngc ns n(urcsnid I� IM1f SII�I�IIp DI�N'01l'1 SIItlII IflII Of Mf IIIICft11�11f1I A)� fCfl5U11 I�I <br />ncndcN. Inw prc�virc rn oihcr cnucc wh;ilawvcrJhc A1N'U shnll nut hn c�ld hnLlc fnr Aemegcs no� shall such faJurt nr mlertupuun lirt en} iensunehlc ume <br />he hdd U� �un.lilWr u hrcnch ol cuntrncl nn Ihr pmt �.I Ihc A1N'U m m m�� wn� rdicvc Ihr cnnmmar. ulmlher tenom or nwn<r. Gum pedarming Ihc <br />uh6Fau�m nl >uch irnnnt'ti ur owner's cunuau \Vxier shnll he uuJ h� npphenm unly un Ihe pamises AesniheJ hnem A nnv npp6enlinn shall he 61ed <br />�hniJJ ��+ur� he Jnned Im alhei p�emise. nllhnugh IncmeJ on ImiJ Annllxd hrrcin <br />�91 lha� ihe �IN II rt�ummaidc In�lallatlnn nf � pre+�nre rrRul�IInK ��ohr. Applic�nt ��knawledkn Infnrmalinn n In Ihe reenmmem6linn �nd <br />xauimr. IIIII ffS�WIRIIlII111 IIII IIIUMIIttlR I�I �MIIIII� III ION�IIB �1RNUff ff�11IP110K \'11I\'f OO IAf Npl[f 11'filltl III �I�IIIHI II ��OT II{RII <br />�If[V�III'1'. � �\-�. <br />� Inl 7 hr �IN�11 uliliin rhrrk �drrs �I lhr mrtrr In prrvrnl x��trr rr�nrninp lu Ihr Uielrkk mdm. 'fhe 111N'U remmmend+ In�ldl�lion of � thrrmnl <br />r�pomian lank lu prr�rnl r�cr��ho prnmre huIIJ-up ruucd b� Ihr w�ler halrr. Applinnl uYnnwkJgd Informallnn n In Ihr rernmmrnAulinn <br />•nd uwmn fnll rrsponqLilil�� fnr in�ldlinK nr fdllnp In Imt�ll � Ihermd r�p�ndon unk. __. _ IN"1�. <br />� �1 <br />�IIt�9�bAU1litPtiti � , . , . ' 1111N�� � HI/N�l: . . <br />� II1'tilAl19/II' . � � . �� I'1.,\I N.4Atl� i � ' � I • � . <br />_ _ . . _ I __ .. - _.. �Ta _�--_. __ <br />uNNi�it'tiNAA11[� I, � ��� / 1/..�- � J L-/ � �-`. I PUAI I)I til�itll IIUN. __� f_� � �...i�,�, <br />� <br />� �wNrr< s nnnurss � '� �._ . � �u� �" C1 --- <br />�'lllYtilAl1/71P � ,.' .. .._ i C.�=��' �_ I111)(il'PRMfI Ititilq?UOY�._ <br />7 hc prrnne•s nn In hc uxd es n . __. � _. _. INfI1kA1A11(1N IPTIIIR IiIVGN. _ <br />tilltvlc'I' 71'PI' �.2lARfih:S. <br />I kcalup<� Insinllyd , U � ti�rvicc ins�nlleunn & cnanection cLxrgc S,_�-t�- —� ��. �� <br />I�nln�l InslnlleJ 121lleneral I'nciliues cnnnerUnn chergr S- ��� ��� •�� <br />I �nbmt Inshdled Ftlme I7� Ulhrr S <br />'I iqol xmuunl �cuiccJ wilh npplirnbun S_ � __ __ .. ' . `�. <br />IT Iti UNIA Ittil � k�U �hni tlu+ Applicnunn. nhhnugh sign<J, shull nM hc MnJmg upon �hc MUKII:ILO WAI I:R UItiTRICT unui eppmveJ by Ihc UISI�HICT. <br />i <br />I. Ilm und<isiynvd. uWncr I��i repnsrmnlrccl idlhr pmpenl Je,enh<J ehow. Au hemAy mnAe epphentinn �in mslsllauun nfa __ .�__ _'inch diemeler weler supplY <br />cen�ice cannenwn, mrluAmE nppnrirnnnces. nnd all nec.ssnq Inhur el nq e�prnses <br />IA��cJ11u� da�nl . . .. � ��l���i <br />:\PI'll(�nNl\'tilli4Allq<I .. .. - ' ..." ..�... . . . . . . . <br />.__ _.___. . . . <br />�\pp6canl'a Nomc IPlcncc prntll � _ .. . _. _ _ . _ - _ . _ . _ .' — -_ � I I <br />� <br />� �' ... . ' i � ,� <br />•�PPlicnni'c Addre�s R Phnnc Numhcr _ . . �. .' . � . � . . „ . �- • , , . � , . <br />�-Ri Ititi t'� �K51 � I Im' i�� iV I Rnl SUMAfANI' AStiLSSMI�N f BACAPI O\I' RI-QUIRPU° YPR _��_ NO <br />I,,panllk�ica SinnfUevice .__ _._ ('r5lniliel�._ ' _ Ueie . �/Zp�7 <br />1 � <br />-\I'I'NU\'t.11! 111 hll IF.1111:17�f:HlqtifHl("f � <br />i <br />��' %JJ .'-,:)-� ;7 ' <br />Ih ... � Unlo.._ . . _ ___ __.. _ __ IssucdBy J��i.. <br />