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N <br />' MUKILTF.O WATER DISTRICT <br />APPUCATION FOR WATF.R <br />.� , ,< < --,.1� <=1Z�15 <br />Mctcr Size: .-_ �---- Srrvice Address: _ � .:�.V _ I_. ��:� '� ' � Accl. No.: <br />, -- - ---- - �---=-`"-- � --- — - - <br />Numbcr nf llnits: _T <br />Meler will be used for (check all Ihat epply): �__ Domestic ___ Irtigation Pire Scrvice ____ Fire I.ine <br />I hercbp npply for �cnler urvice nnd egrec to be govemed, in nccordnncc wilh Ihe resolutions, rules und regulelions of lhe MUkII.TF:O N'A'I1;R <br />Dlti PHIC�I- (M WI )1 pertnining �n H�n�cr scrvice, now or hereoller in eflecl. 1'ht undersigned es owner or reprcsentn�ive of Ihe herein•descrihed <br />prc,nrscs hcrcny ngrecs es rnliows: <br />1I � �I he cnnsumer aprtes In inslell, opernle nnd mniNmn et el� limef, lheir plumhing system in mmpGentt wilh ihe tunenl ediunn nf Ihe I Iniform Plumhmg <br />Gide rts il pennins ln 1he prcventian n(cnn�nminelion. and pmiecuon Gnm ihemul apancion due lo e closed syslem lhat cauld nocur wilA the prnent �v <br />fitlu¢ inslalle�inn a(beckllow prevcNcrs nn Ihc consumcr's xrvicc nnJ/or el plumhing f xlures <br />(21 The rnneumer ngrecs lo inslall ell bncklinw prcvemion ar+emFGes requesleJ hy Ihe M WU, end to meinlein Ihose bxkllaw prevenlion n�ttmbhes in goerd <br />wnrking n�Jer 'I�hc assemFlics shnll I+c o! e lype, sne end makc apprnvcJ by Ihe M0.'U nnd �he Weshmgtnn S�ate IXpenmem nf I leel�h Awhrniry 'fhc <br />n�scmhlics shell hc inslalled m nccarAencc with ell sinndxrJs alehhshcd hy Ihc MWD <br />I11 '(he wa1e� mel<r wdl nol he mstnlled unld n weler use survty has lrern suhmiucd h} Iha eppluem end Ihe Dislricu Cro.s Cannechon ConVul Specle8sl has <br />delermineJ if Ihe cuslome� wdl nred lo Inaell e hockilnw prcrenl<r nn Ihe cuslomar's side nf Ihe meler. <br />(41 'fhnt Ihc cost ul eny eslensinn uf Ih< wme un�¢c, rencwxl, rtpin� � mrnl nr �epnii In rcach end xcrvc Ihe pmpeny descrihed shnll Ac bome hy myscl( oi <br />nxdFnc eti mvnnBl ��I lhc prcmiscs <br />�t� �Ihm oll pipes. wntci mcK�urinF device+nnd ulhar cannecuon eqwpment upstrenm Gum �he melu shell. nll<r Ihch mstnlleunn. IK �nJ Fecnme ih<prnpui� ��I <br />Ihc h1 W U, suhjttl In nll ils mKulnlwns pctlflmmN ��� ��'nle servia <br />�h� 'fhnl n0a inslnllxlion, il mcici or mele� bna end eppimcnnnccs wc Auried �x demoped, lhc owncr, will be held rcs� onsible end <huged for neme <br />171 71�a1 lhc MWD, ih nff¢as enJ nEcnls, shnll hevc Ihc nphl af mgrcss enJ cgres� �o gn �pnn Ihe prtmiscs end pnrymrly dettribeJ hrrem for Ihe pwpnce nl <br />mspeclinn, rnnneclmg nr discnnnecling Ihe srrvice or frn such alhn purpnces d� Ihe service mny rcywrt II is elxn unJersuaJ Awmg the ume thoi eny nl <br />Ihe wma mxins mny Ix aitl nf servme b) rcncon nf en} emergrncy m improvemenls euthnrired hy ILe M Wf), in any slreet nr nlhrr Inwuan in which Ihe� <br />me� hnrc hcen IniA. Ihe MN'I )�vdl m�l hc rtquircJ In fumish wnler Aunng Ihc praprts+uf wch imprnvemems In eny rnnsumer whutt supply nmy Ihu. hc <br />cin ulT, nn c� hxhlc lin nny Amm�gcs lirt ils (edurc In dn so. <br />IXI 'Ihm Ihe MWU shnll hnve Ihe nghl lu chnnge ihc rnles n� nny lime h) Hesotuli�m, ln lempnrnnly Jiunmmue the urv�a lu cancumers, nnd In muall thc <br />mcicr(sl In rcgutu Ihe wola cunsumcd Thc A1R'U shnll nn� he held heFle fnr dxmxpe hy wolrr or nlher ceus< rnulunk fiom Jefec�rvc phmibm{; nr <br />epplmnns mslxllcJ by Ihc nwnri nr nccupom nn Ihc prcmisu supphcs with wotci, and ihe fna Ihm ngenls nl' Iha M W U mny hnvr mspccicd Ihc pLnnhm�! <br />nnd nppinmces slmll nni hc plcnJ nc e Aasls lur rc<nvery in cnsc of dmm�pe ac nGacsniJ I�IIIf SII�I�II)' III W!I[f SIItlII �OII 111 Ilf IOItftll�llCli F) lL�II51111 OI <br />ncc�Acnl, low presnuc u� ulha cnusc whnlvevci, Ihe A1N'U shxll nnl he h�JA liehlc !nr demngrs nur shnll such feilurc nr Im<rmpuun far nny rcnsunxMc iimc <br />Im held la amslilwe n hicnch nf cnmmcl nu Ihr pntl nilhe M W U or in nny wn) « lievr Ihe canxumec whelher Ienonl ur nxne�, Gum pedorm�ng Ihc <br />oMignUun n(such Icnmu's oi uwner's conuxcl W'mer shall be uuJ 6� epphcanl only nn Il�e prrn�ixes dacriFeJ herein A OCK e�I�IIICflll�111 SIIflII h[ GIfA <br />shnulA enlcr he desircd lui oth<r prnnnea nllhauEh IncnleJ on Ixnd JecaibeJ hrnin <br />�9� 'I�hu Ihe 111\1'll rrcnmmrnds In+ullqllnn af � prreeurr r�ululnK r�h'r. Appltr�nl �rknowlydRa Inform�llon u In Ihe rernmmrnd�tlnn nnA <br />uaumn full r<e�fim�Ihillh fur In.IeIIInR ��r 6111nti m hieull � prnem�e regnl�llnR ��Ire on Ihr x�lrr �yelem In protrrl it frnm hlRh <br />pra�nrr. __. :._ IN'1. <br />(IIII lhr IUN'll u111iir� rhacA r�lrr� o11he melrr In prrrenl walrr reuvning In Ihr IIIelrlrh mdm. l�hr 111N'D rernmmend� In�toll�Non uf � Ihrrm�l <br />npen+lnn tadk to pre�anl n�r+�hr prr�eurr Imild-up au�rJ Lg ihr e�Ur haler. Appllnni �cknilwledRa Infnrm�tlon u In Iha rcrnmmrnd�linn <br />�nd �uwn�a full rcepomiLiliy� fnr inelsllinK ai failinR In Inetdl � thrrm�l ��p�minn I�n4( `�;( :_�IN"1�. <br />til�It\9i�1 Alll)ItI�Sti I�... ,� j '.. ., . t� IUI NII I. III(Nh_ <br />_ . . . . - - . . _ . __ —._� _ / ". / <br />I'll1';tilAlll/71P. _ l.�C' 1 t� I'I.AI NAMI' ___ t.!, i i / �•.� . <br />� / . . � � _ i! —� <br />� �N'Nlilt'ti NAMI (,:...�i�'��C ( r^ �"r . . l) (� �,,'. . I I�Ii.AI. DI-.ti('NII'ilnN' �_! L �: c� ___ <br />i <br />� i15'NP:IYti Alll)RI ti\ '_ ..��J� X C� (� .._ 1: `. <br />�'ll1'�tilA'll�//II' � �'��__��- HI.I)(il'PRMIIItitiUFP81'. ` � _i��.- <br />_�_ __' ' .. <br />I hc picmisa arc lu I+c u�rJ n� n. .____..��_ �_ ____ _._ . INPONMAIIf IN If IIlR (11VfiN. .. _ . <br />tii u v u�h: 1 vl7'. illflRc�J s. <br />�- <br />I n����lnpci InswllaA ,. 111 ticrvicc rosvJlnGun R canmciion chnrpc f ��L.� •( ��. <br />I��.vieilnslnlled RllienrmiPoeih�vaconrrumndmige f��'��1�V�•''..'J., <br />I h�inct Innnikd fumrt I1� (hher S <br />lmnlemnumrcrervcdxnhapphcaunn 5.--._. ._-_ _r^�'� <br />I I Iti l iNI1fRti1'1 N IU Ihel lhic Apphcnuun, nhhouEh signrJ. shnll not Irc hmdmg u�m Ihr h11IRII,7l{O W A'1'IiN UIS"fNICT umd eppmvcd by lhc UIS'I�RI('7. <br />I. �hr unAnnpned. nxne� 1��� �epnunmu�� el �d Ihe pn�pcily drscnheJ abore. Jn hercAy mnAr epphe�unn (nr instellalian nf e__� •inch diemeler weler supplY <br />.��n i, c cunnrcliun, mchidmp nppmumunes. miA nll necessep Inhm KI my etpences <br />I I.nrJ Ihrs . .. Jo) uf .. � . . _. . - —.__ _I <br />arrii� �Nis siuNnrnkr _--- I'i,lU <br />:\� pLrani's Nmnc IPlrnsc piinll � , . . . . ' . " _ __ . _ __ <br />.\� p6cnnl's Address R 1'hnnc NumMf ' � � ' � ' _ � _��r'.� S �� ' �I�_ T� �• n 7��1� <br />��K��titil'UNNICIIUN('UNIRt1Lti11�U1AR1'Atitil�titiMfNIHACF:PIS�WR1iQUIRfiU? , LS.�NO wwwqqq <br />I�p����ll7cria _ Sveollkvice _ _ __ CCSlniliels Gte.����- / <br />� y - � / <br />nrreorrf�! ,1Nf�KII:IF.U11AfF:HU1S1N1('1 I <br />;...% "<�_ - um� b'/ ^ �a'•�• <br />Ih � 1�-1--__—______ <br />rP��� <br />I;sued By � �� <br />