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Application No, <br />Me�er Size `% `L� � <br />.r <br />ldUKILTEO WATER DISTRICT <br />SN0�40MISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Number o( Units <br />No. L5 na�13G <br />Account No. _ p �J �� <br />I hereby apply lor water service and agree to be governed in accordance wllh ihe resolutions, rules and regulations ol the <br />MUKILTEO WATER DISTRICT pertaining fo water service, now or hereafter in ellect. The �ndersigned as owner or <br />representative of the herein-described premises hereby agrees as follows: <br />(1) Thnt Ihe cnsl o� any ezronsion o' the wa;nr sorvice, renmval. roplammont o� mpa�r to �eaeh end 6erve the p�o{wrty de6enbotl shall be Eome <br />by myRol� ar pssip�s os ownor (s) of the prem�sas <br />(2) Thnt ell pipoa. watm mcesurinp duhrns end othnrconno:pnp equipmen! upslrenm from the moter ehall, aflerMUlNnstellatian, be and beeoma <br />the proporty ol Ihe M,UKILTEO WATEF DIS7RICT, suhject to eil its regulehons pArtmrnnp lo water nervlee. <br />(3 � That pher instellanon, if inetnr or motar box end eppunnncos ere huned or damegad, tho ownar, will be held reeponsible end eherped lor eame <br />(4� ThatlhoMUKILTEOWATERDISTRICT,ItfiafLcarcendegenls,thellhavethe�iphtollnpraeeenAepre�stnpouponthopreminesentlproperry <br />tloscribed heram fm Ihe purpose ol inspaclion, a nnectinp or dmconnocling tho eervice or for euch athar purposes es the eerviee mey requne <br />It is elso undnrstood A�.ning ihe fime that eny af Me wemr mems mey be out ol eervice by reesan ot eny emerpancy or improvemants euthonied <br />hy the DISTRICT, in any atront or othar locnnon in which they mey havc been laid, the DISTRICT wili not be mqui�ed ro lurnlah weter durmp <br />the propress of such improwmems to eny consumer whose cupply mey Mus he eut oH, or he 6ahle tor eny tlamnges lo� ils feilurn lo do eo <br />; 5) Thnt Ihe OISTiiICT ehnll hpw tho nght lo chenpo Me rarec at nny tima by Fesolution, to tempaarily dlsconUnue Me �arvico to consumers, end <br />t��nsmll�hamotm(s)torogistorthewntarconsumed ThaDISTRICTshellnot6eheldhablelordnmepAbyweteroroMerrauee�esullinglrom <br />dolecuvo plumbing or e pnlinncos instnlloA 6y the ownar oi ocwDAnt on Mn prxmieas euOPLad wlih wator, end Iho fnct ihnt epents ol the D ISTRIC' <br />mny hnve inspoctod Ihe plumbin6 end epphancns sholl not be plaed es e 6asis lor rocovory in eese ol damago es eloroseid. I! Ihe aupPW of <br />wFller sholl latl or ho iNerrupind hy mnson of eeadont, low preesum or other eeueo whetsoowr, Ihe DIS7RICT e�ell eot be held lieble lor damepes <br />no� shall su�h lailure or imerniption for nny ronsonoblo time bo hnld to cnnsGtuto e hreech ol contract on the part o! the DISTRICT o� In eny wey <br />rehove the mnaumar, whoehor tonent or ownAr, Irom podarminp the ohlipetion ol such IenanYc or owner't contred. Weter thell be ueed by <br />epphcam only on thr promisos described hormn A new apphcauon snell be filod ahoula weter be dosved lo• othei premuec ellhouqh Ixa�ed <br />n;�on land destribed heroin <br />(6) The� the DISTRICi roeommend� In�tellstion of � prenure repulallnp val�e. Applleeni ecknowledpe� Infmm�llon u lo Ihe <br />recommendutlon end ee�umes lull reeponslbllity for Inetellln0 or lelllnp to Imlell � pre��ure regulelinp v�lue on the w�tar sy�lem lo <br />� proleciltlrom hlgh preeeure. <br />n, ) The DISTRICT ullllzo� check velva� at Ihe meler lo prevonl water rolurning lo tbs Dislrlcb meln�. The DISTRICT rocommend� <br />Inslelle�lon of s Ihermel eKpendon tenk lo prevent ezceedreprae�urs bulld-up uu�ed by the Wala� heeler. Applleenb ecknowledpef <br />Inlormetlon �s to Ihe recommendatlon end a�sume� Iuli re�pon�lbll�y lor In�t�lllnp or lelllnp lo Instsll � Ihomd aKp�n�lon t�nk. <br />.,-RVICE ADDRESS� •I " � "� �' � _ <br />_ ='y,.� `I ` LOT NO �� BLOCK <br />CITV/STAi E/ZIP: l.. l. �`. i:'', i� <br />OWNER'S NAME: ���'� .. i�l i L' � C' LL� <br />OWNER'S ADORESS�. "�. � `- � � 1�'�� � �.� �-� <br />CITViSTATE;ZIP. L'. �; . �� _ ,�1`I^�� `'I :,�f� � <br />Tne premisos ere to bo used r.� a�!`_� J �� �-�-1-A' <br />��r <br />PLAT NAME i 1. . i -� <br />LEGAL DESCRIPTION�. <br />G�� .3��!] <br />� � I . � 1 " f � _• • /��L%�� <br />.� <br />INFOqMATION LETTER-GAVEiS'cNT ___ _ <br />CHARGES <br />(1) Sorvice fnatallonon d connodion charpe � aao. ���� <br />(21 Gonerel Pedlroee connection cherpe f �'� �� `-� • �� <br />(3� Other f <br />Total emount receivod with appheeunn S �--�� �••' �-�' •�� <br />PAID <br />DEC 17 20D� <br />MUKILTEO W'�TEF U;..,�aLT <br />i�' i� '��N?�RSTDDp thm this Appiicauon, ellhough eipneC. shell not be binMnp upon the MUKILTEO WATER DIS7RICT un61 approvad by Ihe DISTRICT. <br />I ihe underugned, ownor �or roprueent&�ve) ol the propeRy tle6cnbatl above, do he�eby meke eDPliralion for in6tallaUon ol e _-inch <br />a�omular water cyDely sorvirn connp�cuoq 4Winp ppuqenencet e d i nacesta�Jehor et my eRFonses <br />Dated Ihis �..� -- dAY^ �F"-J-%--��—_'1..=— <br />APPLICANT'S SIGNA <br />' Applicant'e Namo (please pnnp -- <br />�- Applican!'t Addrt!ss and Phone Numhxr <br />APPROVED: —^�-�1 <br />MUKILTEQ�LATER DISTRICT <br />g�. ���/ti� --------- <br />� <br />Da1e iL.%/�. /%�'o� <br />� — <br />-%i�l -Ua�3Z. <br />