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MUKILTF.O WATF.R DISTRIC7'
<br />nrri.ICATION FOR WATF.R
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<br />Mc�cr Sizc: , Servicc Address � � .� �' � : ,� • '. .. .'-� _ � --- , ___ Acct. No.: _ � � � �r 4
<br />Nwnbcr of Unils: �
<br />M.eler .��ill be used for (check ell thet epply): �' Domestic ___ ___ Inigation ___ __ �irc Service ___ Firc I.ine
<br />i i,���ny o��i> r��r wx�er service end xqree In he kmemed, in ncenrdnnce wilh Ihc resolulions, n�les enA regulatians of ihe Ml IKII.7'F.O N'All(k
<br />Ulti'IIiICT 1MWD) poNnining lo wn�er urvice, nmv ar herealicr in elleci 'ILr imJersigneJ as owner or representelive nf the hereimdescriheJ
<br />prami�es hercby egrees es follaw.s.
<br />( I I The cnn+umer eprces In m.lnll, nperala nnd mmNnm ot nil umes, Iheu plwnhmg r)s�em in comphenee wilh ihe curtenl edilion of Ihe Unifnrm Plumhmg
<br />('nde ns It petlNins In Ihr �rrcvcnlinn nf colllnmmnlinn, enJ oroleAlnn Gonl lhem161 eMpens: �f. due to e ClUsed syStem Ihel could acur Ni1h Iht prtclnl nr
<br />fuuuc mctalleuon nf hneklloa prcvenlcrs nn !he conxumer s servia end�or el piumhing (izN¢s
<br />�2� 'fhe cmnum<i egrces �a inslxll nll M1nck�Imc pmvenlion assemblies requesled hy Ihe MN'U, mA in meintein Ihose hnekllow prevenlio.� essemMics in gemd
<br />wo�kin@ uidcr 'I'hc dcsemhlics shnil Fc of e Iype, siic enJ meke npprnved hy Ihr M WU nnd �hr N'�shinRtan S�ate Ikpetlment o(Iieahh Aulhnriry "fhe
<br />ti�sembhcs shell hc mclelleA in ncco�Je�m wilh ell s�nnJuJs eswMuhcA hy Ihe h1 WD
<br />(ll 'Ihe woler meler will nnl he inslnlled unul n waler ux surve� has Fren submined hy the epplicenl end Ihr DislricL Cmss Cnnnecunn Cnnlml SpecieGsl hev
<br />Acicrmincd i(Ihc cusinmcr wlll nceJ ta instnll n hnckllne� prtrcmcr an Ihc cuslomcr's sidr of Ihc mcler.
<br />�A I 7hm �hc cosl nl mry ealcnsWn of Ihe xnler snv¢<, ranewal, iepinccmm�l nr mpair In reach nnJ arve Ihe prnperly JcttnFad shell be hamc by myself rn
<br />esupm es nHncq�l �d'hc prcmi.cs
<br />� t� Thn1 nll pi�+. anlcr mc�uwmp dcvacc nnA ul.rcr cnmmcuan cynipmcm upslrtnm frnm ihe mcler shell, elicr thcu mstallnuan, he u�d httnme ILc pru��ry o1
<br />�Im MWU. subjca lu nll C. ngulnwms p<nnining lu xnlcr xavicc
<br />U,1 Tha1 nite mslallauon, il melc� ur mcler Mrr nnJ eppunenenca ere burieJ rn Jnnmged, the nwner, wJ� hc hclJ r<sMimihle enJ chugeJ (nr same
<br />I i 'fhat Ihc MWU, ils alf¢crs enJ ngenls, sh�ll hnvc ihc nRln nf ingrcss end cgras In gn u�m Ihc prcmisa m�J pmpcny dcscrihcJ hartm fnr lhe purpax al
<br />m�palinn, mm�ecling ur AkconnecGng Ihe xerv¢r nr for zuch nlher puqxne+ es Ibv serv��c mnc rcquire h is eisn unArrslond during Ihe lime Ihnl eny of
<br />Ihc x�mcr mxins mny hr nul a(srivia liy rcunn nf ony cmcrgancy oi improvcmrnh ninhnrircd F� Iht M WU, iu nn) s�rccl ��r rnhcr Inrmmn In xluch Ihn�
<br />nmy Imvc hcrn loid. lhc M W U wtll nrt bc «quucJ lu fumish aiticr during Ihc prugrcss nf sudi improvemenl� �a nny cnnsumer whose supply may �hux he
<br />cul ull, or Ac hnhk for nny Jxmngcs lirt us feJurc In An xu
<br />I M I lhnnhe MWD shnll Lnve Ihr nphl ln chnnge Ihc re1�s el nny� um< h� Hnidulinn. In Iempnrnnly d�ecnnlinua Ihe urvice In cnnmmers, mid la invtnll Ihe
<br />me!crls) la reghler Ih< wn�<r rnnsumcA Thc Ml4'l l�hnll nal M1c held hnhlc lirt dnmage hy e�nlcr or Mhe� ceuse rcsulling fmm Jefn:lrve plumhing or
<br />oppGanus mvtnlld F� �he uuner ar ncn�pnm un Ihc premrsee snpplies wilh weler, end Ihe fecl Ihnl agenls n(Ihe MWU mey hnve mspecleJ Ihe plumhmg
<br />enJ nppli�mm shell nnl bc plcnJ ns n basis for ianvrry in casc ofdnmogc as efnrctniJ II Ihc supply uf wetcr shnll fnd oi Ix imcmipted hy mnsnn of
<br />IIIUlICOI. ION �IfCS��ItC Of IIIIItI CRUSf NI1flI11M\'fI, IIIL' M WU SIIqII 11��1 hC IIfIJ IIpFIf Gtf II11t11�kC5IlUf SIIIIII RIICM1 �IIIIIIR �II IIIIfRY�111�0 �tlf fl0) IfeiOpplllf illllf
<br />M1c hclA lo mn�ulule n hmnch o! cnNmcl nn Ihe pan nl lhe M\VU or in nn)� xny rehevc Ihe canvumer. whelhe Iennm m owner, lium pedurmmg Ihe
<br />nh�iFminn nl suah IanwiYs ai ��wnn's mntrncl Wnlc� shall Fc uscJ h� epplirent only un �hc pnnnses J<sciiMJ hercm n ��W a��i��ai��,n snan ne ei�n
<br />shoiJJ wnlen c� de+ucJ lin olher prenuus nllhnuKh Incnled on Imid AexribeJ hernn
<br />1'll �fhnl lhr 111\1'U rrcnmmrnJe fnelallotlan uf o praeuro rcpulutlnQ rdre. Applinnt ��knowleJpre Infarm�llon �e lo Ihe rccammend�0on �nJ
<br />n+umrs full rnpnnxlbllllr fnr In�ldlinR ur fdlinK In Inel�ll � prreenrr rrpul�llnR vdvt nn Ihr w�lrr ey�lrm ta prolerl II from hlRh
<br />prt�mre . IN7�.
<br />(10) The A1N�U ulflim rhrck r�krs �t Ihe mrkr la pr�rrnl wuer rtlurnink In Ihr I/hlrlrte mdne. 7he DIN'll rernmm.od� Ineldl�tlnn nf � Ihrrm�l
<br />np�mim� I�nk In prrvenl ��crecl�r prtaure bulld-up nuuJ bp Ihe w�lrr hrater. Appllanl �cknqwledRa Infnrm�tlon nlo Ihe recommenJ�tinn
<br />�nd namin fidl rnponsibllil� fur ImullinF nr failinR ta Imldl � Ihrrmd e�p�nelnn lenk. /� .. <'�INT.
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<br />t Ifti/tiTA'IT//II' � I � ' I'I.A1 NAA1P .
<br />I1N�NI(It'tiNAMI[ .'IJ'T1 "�I'.'�/�7i:. /?'% L !�� _ If(iAI.U1:tiCRII'71ON ___ _ __ � . �) /r —
<br />11\1'NI-ICti AUI)RI .ti . ' '��' � � .a- • /) - " ' '
<br />�iiti,sinieun j,, ,�i•�r7,����%� i{iuc�rrkn,nittiuiui�r_-- ----
<br />llic prenuses erc Ia be used as n_____ '�'/�'" ____ _, INPUNMKI7(IN 1 I��I I�I�R (IIVIiN: _
<br />sl i<�9l'F 7�.1'PG S11AN4L.
<br />Ik�el�iperincinlled � (Utierviceins�allminnkconnectinnehargr f ����' � �
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<br />Ihdna InslnlleA R14ienrrnl f'eciliues mnnechnn ehmge S ��� �_
<br />I h.�i icl InH:dIcA I ulurc I1) Olher S_—�-
<br />l�rnel mm�wn «cc�vcJ ��i0i npphcnuan S _. .'7 7 '�.'l_�� . _.
<br />I I I� I�NUI ItC I� K N7 ihm �6is Applicmiun, nlihough slEneJ. shnll nrn he bindinE upnn tlm �1UAlI:IlU WAl7iR DItiTRICT until epproved by Ihe UltiTltl(�1
<br />I, �h�� unJcisiFnrd. uxnci Inr icprcsrnii.,ivB ul �hc p•npen> dc.niheJ nhuve. Ju herthY ���o�c epphceiinn fnr msiellnunn nf e_. � .•inch dieme�er we�er supply
<br />�en�iec aunneclio�. inrhiAmF xppwlennnees. miJ nll m•ce�.nn I{�b�rt'I m� erpenses j�.�1 � I�
<br />I I:iIcJ Ilu. � Aa� nl ''j .
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<br />qppLcmn's AJJress K Phnnr Numhe� . . . . J � _ _. _ _ ' - ( c =_- � �' •� .'�� � `!•�'"X/ /I•, �.. . .
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<br />I)pr ol Ikricc tivc nf Ikvicc _.. CCS Inilielr `- f)e�e �T/
<br />APPHU\'ED: '� �II�AIi l!O\\:\1�fJt INti1R1("I .
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