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MUYCILTF.O WATF.R DISTRICT <br />APPLICATION FOR WATF.R <br />Mcicr Size: ___ I � �_ Scrvicc Address: � 1__ ., . .' . � � �. � � ��i 1 1 � � .:--� 11 <br />Numbcr of Units: l <br />— — — --- '----- — — <br />Meter will be used for (check ell Ihet apply): �_ _ Domeslic ____ Irrigation ___ Firc Service <br />Acet. No.: � � L�� <br />Firc Line <br />I hereby npply fnr wntrr service nnd ngrec ta he govemed, in nccordnnce wi�h Iho resolulions, rules nnd rcgule�inns nf the MI IK11,77i0 WATCR <br />hlti fHICT (M WD) perinining to �rmer scr� ice, now or herce�er in ef(ecL '1-hr undersigned es owner nr representnlive of Ihe hercin-ducribed <br />prcmiscs hercby ngrccs as (ollo�cs. <br />( I I �fhe cnnaumrr eF¢es lu install, upanlr end meinlein e1 elI lima, lheir plumM1ing syslem in complientt with lhe wnem addinn nflhe Undorm I'lumhmg <br />Cod< es i1 perinm. In tl¢ p¢venuun nf cnnlaminalion, end prolecunn Gom thennel eMpension due lo e clnud syslem Ihal could occut wilh Ihe prcsenl M <br />fulure mslnlletion nf M1nckOne� prevemers nn Ihe cansumer's semce end/or nt pinm6ing firtwes <br />QI 'Ihe cunsume� egrers In uulnll ell hnckllnw prevenUnn w�semhGes rcyucsleJ Ay Ihe MWP, end Im m�impin Ihose beckllow prcvenlinn usemhGes in g�wd <br />wurking order 'I lic a¢rn�hhcs shnll he nf n typc, siic nnJ meke ppprm�ed by I'rt MN'U end Ihe Weshingtnn Slem Ikpetlmenl of I leehh Authnrity 'fhe <br />nssemhLes shnll be inslelled m nccorJanm with ell slenderds eslnhlished hy Iha M WD <br />l i i 'Ihe wnler melu will nnl he inslulled unlJ e weter use survey hm treen submiucJ hy Ihe epphcml end Ihe Dislricls Cmis Cnnnectinn Conirol Spec�elist hu <br />IlclenNnCA 11 Ihf CUVnlnel will nttd In inslnll e beckflnH' prcvenler on Ihe cuslnmer'S sIA< nl Ih< nteler. <br />Id I Thm Ihc cnst olxny c�tenvun o! Ihv xm<r xervice, rtnawel, « plxcemenl nr repoh in rcxch nnJ servc Ih< prnpeny deccnheJ shnll Ire burne by mysdf ar <br />insipn� es nwnerltl uf Ihc premiscc <br />� 51 Thm nll pi�x.. xmer mertcunnF Jerme+ nnd nlhrr cannecunn ayuipmem upslrenm from Ihe meln shell, pOer Iheu muellnuon, he end Facnme Ihe properq� of <br />Ihc Ai W'I ). sn6Jtt1 In e�l ib rvgulnbuns p<rL�uung lu �wlcr servico <br />pn 'llun nller mslallnGan, dmric� a� meler Anx xnd nppunenences erc M1ur¢d or demageJ, Ihe uHner, w�ll he held rnponsiMe end aharged fur snmc <br />�7 � l�hel Ihc M WD, ils �ill'ittrs enJ ngenls. shxll hnrc Ihe nghl nf inprcss enJ egrrss In gn upon Ihc premisrs nnd pn�peny Aescrihed hcrein for Ihc purpnse nf <br />m+pecnan, cnnneclmF ar dixmmeclmg Ihc uma ar Gn sudi nlhe� pu�wes u Ihe scrvice mq mqwie h is elsn undersumd Juring Ihe nme Ilml u�y ol <br />Ihc wmcr mnins mnv hc uut nf scrvmc Fy rcason af uny em<rpcncy ar imprnvcmenls nnlhorind hy Ihc M WU, in eny sVttl nr alhv locelinn in whidi Ihcy <br />mm h:ne Fran Ini4lhe MN'I ) xJl nul Ac reyuucd lu lumish wnlrr AurinF �he pm@¢sc �dsuch improvemrnis �o eny mnaumet whose eupply mny Ihus he <br />cm ulC on c� 6nMc fur eny dmnngcs for its (ndurr In Ju sn <br />I N 1 1 hn1 Ihe MN'I ) shnll hm�c Ihe ii�hun chnnpe Ihc rnles el anp umc hy ResoluUon, ln lempormily diuonlinue Ihe servica In ennsumers, end m mxtnll Ihe <br />mc�crts) lu rrgiuci �hc wntrr conanncJ 'ILc A1N'U shall nol ha hdd Imhle fai domogc Ay walrr nr nlLcr ceusr rtsuiling from dcfmuvr plumldng m <br />xpphnnces inqnlloJ h) Ihc rnrner nr nccnpnnl mt Ihr premises suppGes xilh weler, enJ Ihr faA Ihoi ngems n(thr MN'U mny hnve mspeclad Ihe plumhing <br />nnd npp6nnccs sh:Jl nu1 Fc plcnd ns n hasis G+r muerp in cnxc ol Amm�gc rtc xlnrrxniJ I�IIIC SII�I�II)' 11( WlIt1 SM1BO �BII Of I)t IOICIIl1�11CA h}' RB1U0 O( <br />ncciJeN, Inw pres.un m olha cnum xhnisrerrr, the M W I) shall nnl he hclJ hable fui Aameges nnr shiJl such fadurc nr imerruplion !nr nny rcnsannM1le lunt <br />hc helJ b+ enn+ldinc n hrcnd� nl cumracl nn Ihe pntl al lhe M WU m in miy wo) reliere Ihe consumer, xhelher lenonl or nwne�, Gom pedomung lhe <br />uhliguWx� �dsuch Ini�nl's m mwci'e cumrnq Wnlc� shnll hc uccJ My app6cdn anly m� Ihc pr<mitts dcscrihcJ herem A OCR P�1(1IICBIIOp SIIflII II� GIf1I <br />shuulA enler bv derinJ Ln athei pwmucs nhhnugh In<oied on Innd descnbeJ herein <br />I�p �fh�l ihr DI\I'U recammmd. In.ulhtlnn nf � prn�urr r�ul�llnR ������ �PP��nnl �aMnowledRr� Inform�llon �� In Ihr rrmmmrnd�linn enA <br />naumre full rnrngslMlil� fnr In.lallinF or fdlfng lu Imldl � pne+nrr rrgul�llnp rdre nn Ihe w�lcr eyslom In pratrcl It frnm hlRh <br />pre�+nre. � ��IN1. <br />110) �fhe 11IN71 nliliirs chnk rahn �I Ih� mrlrr In prrcrnl w�1er returnln� In Ihr Iq�lrlcl� mdne. 7he M11'D rrrnmmende Imull�llon of� Ihermd <br />r�panelan Ipnk In prereN nrasirr prrr�nrr 6uIIJ-up nuarJ A) Ihr e�trr hal�r. Applinnl �tknoxkdRn Infn.nutlnn �� la Ihe rernmmrndUian <br />end nimnrs Gill rr�pnncl6illq� fur imlallin4 nr fxllink ta Ineldl � Ih•rm�l np�ndnn 4nM. __.� IN'I�. <br />tiFltVlll A17UItI�Sti � - . . _ . _ ____ <br />('l ll'/tilA'I I'//IP L . � �. [' � , ' � ] . <br />UK'NI'N'tiNAMP. � ���'. r � (`/�' Oi� /� LL. <br />UN'NI'It :ti AUl�ltlltiti:.. —I �� f.� �� kJ% '-�•� � <br />� _ _ _ <br />�'ITY'/ti"I A�I�I�i/II' _.__. _ _ _. __ � �� � � C--__ <br />'Ihc prcmisa nrc lu bc useJ ns e__. __ _�_ __ <br />sl'Itvll'L:I-�'1'I- <br />Ikvcloper In�lnllyd i � <br />11i.urci Inanlled <br />Unln.t Inelnikd I utua <br />I��I N�1 � ' Nllx'A <br />. . _._. . . __ . _ __.. __ .__.. . . . _ <br />� <br />I.LliA1.U1:SCRIPT —������ /� _�. .r� �. <br />PI A1 NAMI�. _ _( _'; . <br />ION. � � C_ ' _�___ - <br />HI.IHiI'IiRMII-ItitiUliD[iY: 1 ' �J . t �' <br />_r_ <br />INPORMATIi)N I.f."fI'IfR CIIVCN: _ ._ _ <br />i�l�ANliliS. <br />11) ticrvice mslnlleli�m R connecuan cherge <br />(21(irnrrel fncill�les connecUnn chmgc <br />p) t 1lhcr <br />lalnl emnunl incrvcd euh eppluxlinn <br />t � � . ��i <br />f�..� l,�.i),�. <br />S <br />S_—_ _ .-- <br />I I Iti 1 iNUI'Itti I � H 71 � Ihn� �hic Apph<ntinn, nl�hough signeJ, shnll nni bc M1mdmg upon Ne MUAl1.7'Ii0 WATP.R DISTRICT unitl epproved hy Ihe INti118(' I <br />I. �h�� unJnsipnrA. u�curi lur rcp�es<mmi�.1 ��1 Ih< prnpetly des<nbeJ eFnre, Ju he¢by mnke eppbcetinn for irtunlleunn nf e___' _-ine6 Jiemeler weter supply <br />srn ice annncamn. mcluAmE appurirnnncea. nnA all necessnq Inhnr ql my expenan <br />IISIeA Ihis Ja} nl ' _ _ . . ' � . I,r l I � ) <br />AI'I'I Il'AN IR' till iNA'I I IHI� <br />Apphcnm's Nnmc lplcn�r piiml <br />ApphoenYs AdJrecs h I'honc Nim�ha <br />_— _____�- �` <br />NUG 'l :' <br />,� <br />('KuSti('��'VNfI'I�I�.',Vl'UNIHIII tiUMA1AR1'AStiPtitiMFNTBA('Allll\1"RfVUIRI;D^ 5'PS NO�j� <br />�I�pc„II1c�rcc _ tiinnflkvice CCSlni�ieh _ _ UetcfL7/p�� <br />r 7 <br />A19'N(/�'6h..'' NI'KII:fF.1111�A1}:I1111tiTH1('.1. <br />/ , <br />Ih �,.���. . l._. Uale _ _%?�'_//c�:� :' _ IssueJHp - �,��T <br />