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hiUKILTEO WATER UISTRICT <br />APPLICATION FOR WATER <br />� ' � ' J - . ,' '�� d'�. .� ._, 1 <br />Mcicr Sizc � ' � ticn�icc Address: <br />Nmnhcr of Units: / <br />`Mcter will tx used for (checA all thet epply): _ Domestic _ Irrigation _ <br />Fire Servicc <br />Acct. No.: ���� <br />Firc 1_inc <br />I herehy applp for weter sm�ice end egrtt in he govemed, i;i nccordance with tho resnlulians, rules end rcFulations of the MUf:ILTHO N'A1T.li <br />DISTRICT (M WP) {Knaining lo we�er service, noH or herenllcr in etfec�. The undcrsigncd es owner or rcprcsemelive of Ihe hercin-descrihed <br />prcmises hercb�� agrees a� (ollnwx <br />( I) The rnnsumer egrtts lo insmll, operutc enJ mmmam ei ell umes, �hou plumhmg syslem m tt.npliance with Ihe eurtent ediuon of the Uni(um� PlumM1mp <br />Code nc il petteins Io Ihe prcvenUnn of ennummeunn, end pmmcunn fmm Ihertnnl okperismn due to � eloxd system Ihe� eould nc�1r wiN Ne presrnt nr <br />luWrc rosiail�unn n(heckOnw prtvemers nn Ihc cnmumer's sm¢c emi/nr et plumbmg fixWres <br />(:1 The consumer eRrees to mstell ell Aeckllnw prcvemion usemM�es rcqunmd hy �he M WD, md m meiNam Ihose hackflow prevemian acsemh�ia m F�wd <br />wnrl:mg rnder Thc sssemhhes shell hc a! e t�Te, ene end moke eppmved h�� ih< MWD and lhc Wvhingtnn 5[ete Uepvtmrnt of fleelih Anlhnrny '�hc <br />iasrmbhes shsll Fe insulleJ in eccoNence witl� eIl sunduds rslnh6shed hy Ihe MWD <br />f3 � 7Te aaler met<r will nni be msie�led umil e weicr use survep hac been submitled by Ihe eppl¢ent enJ Ihe Distncu Crens Connecuan ConVat Specul�st has <br />demrmmeA il Ihe cminmer wilt nmA Io �nslall e heckOnw prcventer on Ihr custnmer's vA< nf Ihe metet <br />IA i Thni Ihe cosi of enc eclenvnn rt Ihe weler urvieo, rtnewal, replecemrnt nr repeir �n reneh end serve ihe pmperty drserihed she:l be hnmc hy myself oi <br />aasign� n+ nwneqs! nf Um prcmisu <br />15 i Thei ell pipes. wemr menvunn�; derim enA mher cannecunn eqwpmrn� upstrcem tinm Ihe memr sheli, elter Umv mnalleuoq be end heenme Ihe prnpeny n! <br />Ihe M WU, suhlcet In ell its rcFuleuons penumnF tu antrr serv¢e <br />1(�1 '!hm aller msteileunn, i( meiv ar mner Am end eppunenanca art huned rn demeged, the nwner, wdl be held ¢spon! ��le end clmrped (nr sem< <br />17� Thm Ihc MWU, i�� oll'icers end egrnLt, shall hnvc Ihc nght nf mFras end cQl�ss m gn upnn Ihc prcm�ses end prcryicny aaeribcd hcram fnr ihc pwpmr of <br />m;peclinn, mnneamg or ducnnneclmg the cervitt nr fm such nlher purpnses as Ihe cerv¢c ma) reqwrc II is elso unden�nnd during Ihe tlme lhnt �ny a! <br />Ihv weler m<ins me�� hc ow of scrvmr hy rcrt�on nf eny emerprncy nr �mprovemenls euthmveJ hy Ihe M11D, in enp sVeet nr Mhn locaunn in wh¢h Ihev <br />mn� havc hecn Inid, lhe M WU will nnt be rcqwrcd tn fumish wamr dunnp Ih: prnFrts. nf such imprnvemems In em eonsumer whose suppl) me� ihus be <br />cut n0-, nr bc hnMa far pny dmm�Fa fnr itc fnilurt In dn sn <br />�NI 'I'hm Ihc MW U shell hnve Ihe nght la ehenge the rates at eny umc hy Rexuluunn.lo mmpnnrilc diswmim¢ Ihe scrvi¢ tn cnncumers, end In ms�nll iho <br />mcicqx) In rrgisln Ihc waler cnnsumcd. The MWU shill nnl bc helA 6alrlc lar dnmegc hy weter ar mher ceuvc ra�Jlmg 6om delearcc plumbmE ur <br />nppliences innelicd by Ihe nwnn or occupenl on Ihe premises suppl�es wilh weler, end �he lecl lhet agenLs nf tlic �1N'D mey iieve inspaleJ Ihe plumhin�� <br />nnA nppGencex sh�il nm he plcaJ ds n haas for rtcnvep� in catt nl demege as afnraud. If Ihe supply nf we�a shell fsil or be imerrupleJ by renson nt <br />ncudent, Inu� prtssurc nr nlhe� caua ahels�uva, Om MWf) sl�ell nnl bc held Imble far demeges nar shell sm5 feilure nr mlerruplion Inr eny teuawblc umc <br />hc hclA 1u conslilule e hrcech af cnnunct on �he pen nf Ihe MN'D nr m nnc wey reGeve Ihe cnnsumer, whelher Icnnnt nr nwner, 6am pednrtninp lhc <br />nhLEeumi nf such IcnnnYs or uwr.er's cnnuact Weier shall be useJ by xpplicem nuy� on �he pmmises descriheJ hercin A new epphution rheP be Illed <br />xhnulA wn�cn c� dcsirtA Im olhcr prcmiscs ehhnuEf� IncemJ nn lend dcscrihcd htt<in <br />1'�I 7 hu Ihe M\{'ll rrcnmmends Ineullolfnn af � pre��ure reRulAlin� vdvr. Applfnnt �eknnnled�ee Infnrm�tinn u tn the rcrnmmrnd�llnn �nd <br />�+sumrs fW� reepnnelbNlh fnr In�1�IlinC nr fdlin� In In�lall � pree�nrr reFnlalin� vdvt nn Ihe w�lrr qaltm in pmleet 11 from hi�h <br />pra+urr. ( " INI. <br />I��I 7'ht �1N'll n�ilixt chrrk r�h'r� �I lhr mtter In prrvrnl x�irr rrlurnfng ln tht bialrltls m�ins '1'he 1�N'U rnnmmrndx imtdl�tlnn of � Ihermd <br />np�mion I�nk In prrvenl rirrssicr pres�nrr bnild-np nu�<A In Ih� w�kr hr�ler. ApplinM�u�Cnnwled�n Infnrmatmn �s lo Ihr r.rnmmxnd�linn <br />�nJ �evimr� (nll rcepnnelbilitc Im� imulling orlailin4 tu insull � Ihermd rspaminn unk �_� __ INi. <br />tillt\'I('I. AI1171t1titi ' �� ' � '—' � � I (11� NO �' _ f1L(K'F: _ __ <br />_. _ _..—__ ___ _. �, i i <br />_ _. _ -. __ _. . <br />i___ -_ . . � . . , <br />�'lil'/tiTA"IlIlII __ % �� . 't � �. PI.ATNAML _ /�� ./ . 7 � = � ._ <br />i �1CNI�K'ti NAMI . �.. � � '� � � ": " I.F.(iAl, f)I'SCRIPTIOh� /!F /// `.' -/� � _ <br />n�VNI�.IYti AUIINI.Sti .' %'�'.. /'i . /� !�^�i�' % J :'% �-' / jAL ✓"'� . ._ <br />� i ���s � n rrnm "`� _ i�i.uo rreMrr issur:n nv _ -- — <br />1 hc pmmua mc lo M uud es e <br />si u��ICli�]7'� <br />I kvrluper InstalleJ� V . _ <br />Ui.vin Innelled <br />I h.inci Insulled PWurz ___ _ _ __ <br />MFOItMATION L[TTI3R (iIVEN: ___.. _ <br />S1V�N4f:ti- <br />( I I ticrvmc ros�nlleucm & connecunn chargc f �' ��� ���_ <br />/ii�� ,-�� , <br />R) Grnerel fecihGa connecunn eherge f y ___. <br />�)] Uthcr S _ . <br />7atninmoumrccc�vcde��lheppliceunn f__ y��. <br />I I IS UND172ti�i ( x1D Ihm Ihis App6cauon, nhhnugh si�ncd. shall nm hc hmdmg upon ihc MUI;II.TCO WAT[R DISTRICT until epproved h� th< Ulti I1iH �1 <br />I ihr unAersiFnod nunn I��r rrprrsemeuv<I nl Ihe pmpem drscribed ebore. dn hemM1r make epphceuon for mstelleuon af e_ <br />t���� icc connccl uniincluJing appiM1tcnnncrs, pnA ell nactsnp Inhnr el mp capcnses <br />I 6vcJ Ilus �`� do1 n! —' � � "'. � . • <br />_.._ _ ._ _ . _ . �—r_____— _—�_._____'_ _.. <br />\I'I'I It'ANfti' SI(iN!�'IUkI ' ��_ + i ����� ... <br />4�q�hcnm's Neme Iplrs,e pnm I l C'.m �( L� i� _ �` C ' n no�1 ___ __ <br />�?Z G - �- <br />'�PPIivnYsAddrees3PhnncNnmber �_`1_��r_u)U�1 �tr �U� __.�1r1t1 � l'.iN ,�-t_I <br />� <br />-mdi diemeta we�er .uppl� <br />t�R� �Sti CONNIiI"I111N ('OMROI. SUMMARI' ASSIitiSMENT HAC1:19 (�U' RP.Vl�IR1iD� 'IIS /� NO � <br />l�pcaffR�itt . .__ __ _ ___ .. SittoflXvire _ CCSIniUels Uele _�GK <br />41'I'NO\'k:l//: /j . tl iAII.TF.0 \1�AT'!:R IIItiTRt(9� <br />I�� ' ,�" �� �f�' . .. I�mc _ ���/� __.—_ <br />/ <br />PAID <br />AUG1101 <br />MWVVG <br />� / <br />Issued B� �''_-"�_ <br />