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� <br />�'MUKILTF.O WATF.R DISTRICT <br />APPLICATION FOR WATER , <br />,i- , . <br />Me�er Sizc: I Servicc Address: I I:.�.. '� i� r ;��-_ �(_,.. 1 <br />Numbcr of Units: _ 1 --- — _ - — - — - <br />Meter will be used for (check ell Ihet apply): �_ �iomestic ___ Irtigetion __ fire Service <br />Acct. No.; � � � � �O <br />Fire Line <br />I hcnhy npply for e�aler scrvice nnd ngrce to be govcmcd, in eceordnnce with Ihc resolulions, rules nnd regulatians o(Ihe MIIK11.77i0 N'A1};H <br />I>Iti1RICT IMWI)) pennining to �enicr servic0. now ar herenller in eRecL 'fha undersignrd ns nwner m rcpresentative af �he hereimdescribeA <br />prcmiscs hcrchy ngrccs ns fnllows: <br />( I 1 �Ihe enncumer ogrcec In mslell, npere�c end meimein e� ell umes, Iheir piumAing syslem in cnmplience with �he wrtem ediGnn of lhe I lniform Plumbmg <br />Cnde es il peneins In Ihe pr<ven:inn nlcnmomineli�m, end prnleclinn Gnm Ihermal eepension due lo e clnsed syelem Ihnl cauld accm wilh Ihe presem �x <br />(Wurc inxtnllnlinn uf hnck�nw preven�crs on Ihe confumer'e servim nnJ'nr nl plumhing (ixlures <br />121 The cnnsumtt ng¢es In inslell ell LeckOaw prcveminn nssemhhes rcquested hy Ihe MWU, end m meinlein Ihnse back0ow prcvenli�m as�tmbhes in g�d <br />anrkmg oidcr lhc esscmhlin shell hc ol e I�pe, sbc enA mekc eppruvcJ h� Ihc M WD end �he Wmhinpton Slem Ikpenmem of Heelih Amhonry The <br />sssemhhcs shell br inqelkd m nccnrdxnce wilh nll slenderds rsinhh�hed ht Ihe M WD <br />U 1 l�he wmer metcr w111 na� Mc inslnllcA unul e wemr usc survry� hn. Fcen whmived hy �he epplicent end Ihe Uislricts Cmsx Conneclion Conlwl tipecielis� hes <br />delemuned t( ilm cuswmn will nvcA m msinll n bnckliox ryn�aN<r nn Ihc cuslnm<r's siAe n! Ihe meler. <br />I1) 7bN Ihe cosl ul nny c�len.mn nl lhe w:nrr scrvice. miexnl. rrpincem�m a� rcpnu In rcnch end serve Ihe propetly .esuibed shell he Mnme hy myself or <br />nss�pnr as oHncqcl ��f Ih�• prcnnsex <br />15� Thn1 nll pipes, Hxler menvumF devias nnJ nlhe cnnnecuon eympmeN upslrrem finm Ihe meler xhell. n0<r �heu mslellnhun, hr enA hreome Ihe pru�xrt� nf <br />ihc A1N�I7. SIII1Jf.11 11� flII IIs fl'�IIIOIIOOti �1fflRllpll�t IU \1'OICf SCfVICI <br />In1 Thnl nller mslnlleGnn, illncler or meter hax end eppunennnces e¢ hurieJ ur demnqeJ, Ihe rxner, wdl be hclJ rcsprnisihle end chnrged "m sami� <br />171 Ihnl Ihe M WU. ils nlLcers end ngenls. shnll hxve ihc �ighl o( ingress end egrecs In gn upnn Ihe premises unJ pnMerly descrilKd hercin far Ihe puqw�u nl <br />m�pca�on, rnnncehng nr Jhconn<clmg Ihc ttmtt nr lirt such nlhr� pnrpnccc ac Ihc snvim mny reqmre h n ekn unJersumd dmmg tlm umc Ihe1 en} nl <br />Ihr wmer mnins mny Iw nul nf sen�ice by ¢nsnn n( miy cm.rgcncy nr improvcmenls nmhunxA hy Ihc M WD, in eny slrttl rn ulher I�Ketion in which Ihey <br />mn� hm�c hccn loid, Ihc MN'U will nnl hc rcquireJ lu fiimish wata during Ihr progress nf such imprmrmcnls In nny <nnsumer whnse supply mqy ihus hc <br />cul u0. nr Ik habk !u� nn) Amm�ges lirt ils Gulu¢ lo Jn sa <br />IN 1 lhnl Ihc MN'U shiJl hm-e Ihr righUn chnnge Ihe mms n� eny ume hy It<suhumn, ln Ienipnrnnl� di¢nntinue Ihe service In ennsumers, end lo Ins�nll ihc <br />nre�crlsl ln rcFislcr Ihc ��mn cnnsvmcJ lhc �1H'U s6nll nal hc held hnh4 fnr Anmagc hy xnlcr nr olhcr cuue rcsuhing Gnm defce�ivc plumhmg or <br />npphnncn mstnlleJ h�� Ihe nwnu nr nccupnnt nn Ihe premises supp�ics wlih unkr, enJ Ihe fn�l lhm npems nf O�c MN'U maV heve inspecled Ihe plumhing <br />nnd npphnncn shell no1 Fe plrnJ rt� e hn�is frn rccnrrry m ensr of Jnmoge n� efnmsoiA Il lhc supply af wekr shell feil nr Ae inlem�pled hy rcqsun ul <br />imaJem, law pressurt ur aiher cm�se whmr�kver, Ihe M W U shnll no1 Irn c�lA hehle fu� JmneNes nur shell such failure m imenupunn fai eny renxunnhle �nnc <br />hc hdJ lu annxinule a bicnch al cnnlmcl on Ihr pen �d' Ihv MWU nr m nity �eip� reheve Ih< cnnsumer, whelher Ienunl or nwner, Gom pefnmung !he <br />nhliFnunn al wdi Icnnnl'. rn mwer's cmurnct wxmr shnll Fe used h)' epplicenl any on Ihe prcmises dereriheJ hcrein A nea� nppl¢eunn shnll he filed <br />shinJA wnlcr be de�ueA lin nlhn pmmi�cs qllhnugh Lan�ed an lend descnFed Lerem <br />pq Th�l Iha �t\\'D rrcnmmrnda ImtallMllun nf� pmavr reRuhllnR vd�-r. Appllrnnl uknawlcJpr� Infarmulnn n In Ihe recnmmenJ�llan �nd <br />nnumrn full rnpnndbllity far In�lxllin�; or fdlinF In In�ldl � prneurr reg�d�ling vaA�e nn Ihe w��ler ey�lem to prnlecl It hnm hlRh <br />prra�urr. IN7 . <br />I I01 The M\1'll ullller� rh�rk rdwa �I Ihe mHer In prcr�m wurt rrlurnink to Ihr binlrlrb mdne. The MWD rrcnmmrnd� Imtdhllon ol � Ihrrm�l <br />rtp�n�lon I�nk lu prevrnl nrreeicr prresuro bulld-np c�uerd M1y Ihr w�ler hnlrr. Appllc�nl uknowledqa Inform�Nnn u lo Ihe rranmmenJ�Unn <br />�nJ u•wnn full ropnndbiliq fnr in�lxlllnk nr fdling In Imtdl � Ihrrm�l r�p�mlun I�nM. INI�. <br />�IltVll'I'ADUItI[.titi I ' .- .- . � . I .. . •`� 1.11fNc1 I �—+� t IIII7l�A . <br />�'115:�SfAI7'://IP. ( '.� � `�i�j��� PIA1NAAll. 1�-.!��', �t r .. --� --� .. <br />____T_'—____"__"_.._. .__ . ._'.--_' :. �.�'�7 <br />�rll'�'JI-It'tiNAMP � � c� 1� 1� �� ,�:i L. I i �.. �.. � II�IiAI hl�til'kll'll(1N ...�.� t �r -J lJ O-. <br />i_" _ __. . . _--' <br />n\�'NhN'tiAl)UI<I\ti � �_.1'� C',_, . . �� <br />� I I 1�'ti I A"I�I'//IP ..�� _� �, BI.Uci I'h:NMl�I� Ititil IIiU IiY , � �. _� -l� <br />— � -- .. <br />I Lc premisa me In he uaed es n._______ __ INPUNMA71ON I.I�.TfIiR (iIV1iN: __ <br />til u�91'[. �Il'I'f ('IIAHc+I�ti <br />I k�alupci hislnlleA �� 111 ticn�ice inslnilxwm A connecuon eherga f `I �J •� ..:' <br />Ui.iii,�InnnllrJ 121(icncrell-ecililinamncclmn[hnrgc S� T�' � <br />I Iniii, I 6i�talkd I ulurr I11 f Nhrr S <br />1 ulnl emnunl rtanr:A anh eppGrnuun S _ J -� �l - _- __ ... � �... ) <br />I I It I iNl ll iis I� N ill t6:u ihn Apphninun. ahhnuEh �iEncJ. shall nol hc M1inJmg upon Ihc MUKII:I�IfU WA'f1iR I)ItiTRII'1� unlil epprovcd Ay Ihc Ulti I Rli � I <br />L ihr uuJ�•isiEned, u��m�i 1,�� ��•pi��.�•iii��b�d �d �hc pi�ipeq d<ecnheJ ehavq du herch} meke epphcelian fnr inelelleuon nf n �._ �inch diemeler walei supph <br />xnire �um�rcunn. mcluJmF nppunennnce+. nnA nll neassan h�hm ni m> etpensn <br />I�:nvA Ilu� ' J�n ul � , ' . <br />AI'I'1 U'ANIti'ti11iN4111R1� <br />AppL.nn11 Nnmr Ipleme p�inn <br />Applicmit's AAdres A I'hnnc Numla� <br />i , . <br />. . . /'. .. I . <br />" _,__' ._;;' _. — _' i <br />— — — - --� �� � _----- <br />t�RrnS('�lNNfl'iluh(��IVIN�H tiliAlAtAN1'Ati51�tiSMl'Nl'HACAFLUN'RGf)IIIRI�D1 YFS u� N`y'��y�/� I,�` <br />I�prnll)c��cc tilvcn(fkvice ___ ____. CCSlniliels� \ Detd,.. /�r/,GY'Q�% <br />, �fl <br />�U'1'RI/��EU.'�f ��II'AIIl�E11N�.ATEHUlti1711('1� . �� / <br />� � .�; : ..�r-� <br />Ih , � ' � U;nc � / - .. ! �_ . �. IsvueJ If� <br />i j <br />� <br />