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� ' MUKILTF.O WATF.R DISTRICT <br />APPLICATION FOR WATF.R <br />� � /�J�!'^ �i�rG' i`%� �� '� �' "I � �� <br />Metcr Sizc: _ r Service Address: _ _ __ __ ____ . _ _. _ �__ __-- Acct. No.: _ _ _ <br />Numbcr of Units: <br />---- <br />Meter will be used fnr(check all Ihat apply): _ V__ Domes�ic ____ _ Irrigelian ___ Pire Service .____. Fire I.ine <br />I hrreby npply fur weler service nnJ egrec in Ac govemcA, in eccordnnce wilh �hr resnlutions, rules end rcgulalions nf �he MUICII.Tf?O WAl'I:R <br />I lI5fR1(' f(M WU) p�h�ining to wmer scrvicc, now or hercnller in cf(a�. The undersigned es owner or represeninlive uf Ihe herein-describcd <br />prcmiuc hcrchy ngrccs ns folinus�. <br />I I) l lx canxumci nprecs In imleli, upernle nnA moimnin ei nll umrc, lhev plumbing sysicm in comphentt wilh Ihe cumm ediuon nf Ihe I lnifnrm I'lumbmg <br />('uJe n+ il penains lo Ihe prcvenuun uf cnnlnminnunn, enJ prolec!���n Gnm Ihemiel expensian dur to e dosed syslem thel could nawr wilh Ihe prcsem rn <br />NUirc inslelleunn nlhnek0aw prrveNe�s nn Ihe cnnsunmr's s<rvice end�nr nl plumM1ing fiztures <br />121 "fhe consumer eg¢es U� instnll nll hnckllux prevenlian nssemMics requesled Fy Ihe M WU, end In mei��ein thme beck0ow prtrcmion a�semhlies in g�d <br />wnrAmF nrder ihc asumhlics shnll he af e IyM, siie end meke epprored hy Ihc MWU end Ihe Wa+hingt�� qek Ihn:;imem nf Heellh Aulhnrily 'fhc <br />easemhGes shell Fe insinlled in r.ccnrdnncr wi�h nll stnnderds esleAluhed hy Ihe M W D <br />� 11 The wmer meler will n��l he ins�nlleA umil e wmer use simey hnc h<en whmiU<J h� Ihe eppGcenl end �he Dislricls Crnss l'onnecunn CunVoi Speciaiis� has <br />Jele�mined iflha nnlnnx� xlll nnJ in inctnll n beckMe prevenler on Ihe cuanmei's siAc of Ihe meter. <br />IA 1 Thm Ihr cnsl al nny r�lenvi�.n n� 1hc wnler scrntt, rrnaad, mpincemcm ur r<pmr w¢ncL nnA xenc Ihe propehy dacriheA shell M1e Fnme Fy myself nr <br />nssign� es nwncr(s� nl lhc pirim�ct <br />�5� Thel nl� pi�s. Hx�cr mnnwmF Aevices nnJ olhci cannccUun cywpnmm upslrcem (nrm Ihe n¢Ier ehnll. e0cr Iheu m�lxlimion. he mA beeame Ihc pru�Krry ul <br />thc MWU. suh�ccl ln nll ib IcEulnllunc pctlnining In wnlCf scrvlcc <br />Ibl -Ihm eller m.tullehun, d mctc� ar melcr hm end nppwmnnnces nrc huneJ ar Jmm�ged,lhe nwn<r. will be h<�d rcvpnnsiblc nnd chnrged fui tame <br />17) 'I:ml ihc A7 W U, its allitto and egcnls, shnll hm�c Ihc u�ln af ingrss nnd cgrcss lo gn u�m Ihc pnnuccs end puryrcrty descnhcJ hcmm fur �hc purpasc ut <br />mspeclion, rnnnecung oi dhcunneclin� Ihe scrvice ar fnr wch other parpnsrs ns Ihe sen�¢c mn� require h is alsn unJarsi�d Juring Ihe Pma �hm xny nl <br />Ihe xnler mains nmy Ix nu1 af scrviu by r.nsnn ul nn> <merRency m improvamm�ls eulhun:ed h1 ihe M WU, m vry� slrttl or nther Lxelinn �n uluch Ihry <br />mm hme hcen Imd. Ihe A1N'I1 will n��1 Fc rcqwreA lu fumish �reler JunnF Ihe prugmsc nf sudi imp.nvements in eny careumer whnse supply n�ny Ihus hc <br />nn ufl. an c� hnhlc lin nn7 Axmn@cs lirt ils (ndure In du xu <br />1N 1 llinl Ihe MN'U �hnll hnve Ihe npin Ia chnnge Iha rales m nip ume F�� NesolWinn, In I<m�xanl�� Jisconlinue Ihe scrvlce In cunsnmers, end In mstnll the <br />mclerlsl la rcµutc� Ihe wxler consumeJ "I Le A1 WU xhal� no. M1e hclA hnMc lirt Jnmege hy wmer nr olher emis< rcadtm@ lium Jrfaclrv< plumbmg or <br />npphimccs in+InllcJ h} Ihc nwncr nr ncaipnm on Ihc pranius supp4cs uilh �cnl<r, and Ihc fea Ihm egeNs of Ihc MN'U mny havc rospccicJ Ihr plumbm�! <br />nnd n��phnncrs .rhnll nul he plepd ns n hnsrs lirt rccnveq in cnse af dmm�Fc rts aforaniJ If Ihe supply nf wo�u sholl fail or Ix mkrrupleJ hy ren�un n( <br />accidcN, lue� �nesarc nr nlher cnuse whnk�Kver, Ihe MN'U shxll nm Me hdA hehk fnr denmgev nnr shnll such fxilu¢ nr imerrupunn (nr eny renwn;�blr ume <br />hc helJ In cun+litule o hrench ol cu�nrncl an Ihr pnn of Ihe M WU m in miy xny rcheve Ihe cunsum<r. a�hclhe� Icnnnl ia nwner. frnm pedurming lhe <br />n6L�mion ol euch knmifs oi nwncr'+ cununcl N'xlcr shell Fc ucaA h7 epphcam anl� on thc pmmiscs dcscribcJ hcrcm A nca nppl¢euon shell bc IiIcJ <br />+huulA w��er Ix dcsncd �irt nlhct premia� nllhough Lxeltd an Innd Aescribed harem <br />pll �fhal Ihe �I�YU rrcommenA+ Imt�IlaUan of � preesure repul�lln�! vdrr. Applic�nl �rMnowleJRn Informulon �e lo Ihe rrrnmmend�llon and <br />�s�umrn full rrepnndMlily fnr In�ullin4 nr fo0in� in Imull � prnwrr rrpul�tlnR rdvr nn Ihc w��rr ey�lem In pm�ec� II from hlRh <br />prce�ure . _. Itil. <br />�I Iq l�hc �I�PII ullliirx rhrck �drn et Ih� mrl<r In prercnl wxlrr r.InrninR In Ihe Dhtrlcta mdm. The M1IN'U rerommend� Imldl�lion nf � thrrmd <br />e�panalnn lenk �n prcrrm �xcenAr preanrr Iruild-up auecJ by Ihr w�ter hr�ler. Applfunt �eknowltJRr� Inform�llon u la Ihe rcanmmenJ�tiun <br />nnd aaunv. fnll r��pan�ibllfly fnr fm�ullin4 m fuflinR In Insull � Ihrrmd e�p�nelan t�nk. �'=.- �INT. <br />,: i �. .. � �� � r. <br />SIitVLL'bAUUlth:ti5 ' � .:� . � ':� ��' IIfINO / . ..__BL(ICA _ <br />. __ . ..T__.: . ,�, _.._.___ ... <br />t'll5';tifAll�//IP�. . ' ' :� - . I'IATNAMP. _ _ _ � � �. ._ . _-.T�______ <br />uN'NGIt'tiNAMI�: � t'��� ,-.� .—jm�.i �<v II'�iN.Ult.l'CRIPI7ON __. ____.__j,,T-- . <br />-• ;. )�t I .,. , <br />ull'Nllt'ti AI)DIiI�tiS .� , �_ _ � ___- . - --- <br />� /. i' !. �� HI.U(i 1'CRA11 f ItitiIIPU H1'. <br />l'liYltilAll'//II' '� � _ _., �y __— —_. - <br />1 hc �Lfll➢cCf Pff la (M IK[A 115 P .�� I� __ __ INPURMA I IrIN Ill"I'fl(R IiIVFiN: .. <br />lllt\'14��;.1)'!7i 4111�R(i1:S � <br />i�.,3„ ; <br />I �rvcluper Instnikd U I tirrvice inanllnlion h connecuon ehmge S._�� _ <br />Ih�incth�anlled 121(i<nernlPncililiesconneclmnchnrge S_''� <br />I�nw.l lu�inlleil I ulwc 1? I l)Ihri S. _____'. <br />r � .� i <br />Tominmuunueceiredn�ihnppllcnuun S___.�'..��—_ ___. <br />II ItiI�,;IH�ittil�H�l�tlraiihn,\pph.xii��n ul�h��uplisifurJ.sh;dlno�hchm�6ngu�ron�h<MUKII:II'UN'ATIiNUISTRICTuntilnppmveJbyihcUlS�I-RI�'I <br />I ihe undenignrd. �mner 1��� i�•P��•eN:nicel ��I Ihe pinpert� Ae�cnFeJ eFnve. Jn haeM1) meke eppGeelinn (nr mslnlleliun nf n__, _-inch diemeh�i5i�1�S�rri> <br />+ei��ire cnnnech�11�. inclndmg nppnnen�ucs, nnd nll necessnn��InMq el my erpenses <br />I1:ncAllus � Amul ,.� � _ " � ,��_�j - <br />i <br />AI'1'1 Il'AN'I-ti' S1( iNA I I �I<i� <br />Apphcmn'� Nnmc IPkxse pun0 . ' . <br />4pphcnm'x AJJrtxs k Phnne Numhcr ' __ <br />_ _ . _ __...__— —'1`��.��,. . <br />� ...._ _ __. .._.,.-;—,'G-•,"// <br />CHUtiti l'UNNPI'I'IUN CUNiHUI. til IAIMAHI' Atitil[titiA1P.NT OACAPLnN' NI?UUIRIiU? YIiS � NO —, ��� <br />`T��. <br />1)pculPcvicc _ tivto(Ikvicc _ _ CC:tilni�ielr __ Dete�� <br />:U'I'Itll\'E6: !� �IV611lEORA1�IlUqtilltl('f / <br />. i. � : � .. ...� <br />Ih � . . . I)alr . . � ' _ Iss�md H) . . <br />_1 <br />� I <br />