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<br />MU61LTE0 WATGR DISTRICT
<br />APPLICATION FOR WA7'ER
<br />Metcr tiiir�. �-�u Service Address: �/�%- �:�/!✓.�: -+: /l� Accl. No.: �4�_� �
<br />�lwnhcrofUnits: �
<br />Mcier will be used for (���eck all that epply): ✓ Domestic Ivigation fire Service __ Pire Line
<br />I hcrch� iipply fnr wntrr scrvice and agrce to ba pnvemr.d, in accordance wi�h �he resolwions, rules end regulatinns of the MUKILTTiO N'ATER
<br />Ulti I7tIC"f (M WD) pertaining m water service, now or hereelter in eRecL The undersigned es oHmer or reprcsemetive nf thc herein-descri6ed
<br />prcninn hcreby ecrccs es (ailows.
<br />( I� The consumer egrecs 1n mstell, nperele end memtem et dl times. Ihev pinmhmg system m camphenec wilh �he curtent edmon nf Ihe Unifartn Plumhmg
<br />Cnde ss iI pertems In 1he prevenunn o! contamineUnn, end proteuian linm lhertnel apansinn due in e eloud syslem Ihet cnuld ocew with Ihe prcsem or
<br />fulure ms�a�leunn af hackilnw prcveNers nn Ihe comumerb service nnd/or et plumbing Gtwres.
<br />Q i The ennsumer e@¢es tn mslell ell hackllnx� prevenuon nsumbhes « qucued by the MWD, end lo memum Ihnse 6¢ktlow pmvention scsembhrs m gund
<br />wmkmg nrder The ecsemhl¢s shell he of e type, svic end meke epprnved hy Iho MWD end the N'd�hin�ton Steu Depenmrnt nf Heellh Aulhonq. Thc
<br />essemhlies shell Ac mxulled m eccordnn<e .vilh eIl sunderds esublished hr the M WD
<br />� 7 i iTe weler meler will nnl A�� mstalled uutil n weler use survcy hac Feen suhmnted hy Ihe epphcam end Ihe Districis Crms ConnecGnn Control Specidist hss
<br />dciermmed i( Ihe curtnmer wil I necA In m.;Inll a beck0aw preventer nn Ihe cuslnmer's side of Ihe mcler.
<br />pt i Thm Ihe cnx� nf eny exicnvnn ntlhe wsmr semce, tenewel, mplecemem nr repmr !n mech �nd serve Ihe prnpeny deserihed shell Le home 6y myself o�
<br />acsigns ic nwncqsl �f Ihr pmmua
<br />�51 The1 ell pipes, wner men�unnp dev¢u end nUicr cnnneumn eqmpmrnt upsirenm finm �he mcler shell, eller tl¢rt msulleuon, be imd becnme the propenr nf
<br />Ihc M WI), suhjed In dl ils rtguleunns penammg In wuter scrvitt
<br />1�� 'fhn! elicr inxt�ll�uon, if mtkr or meter Mix enJ eppunenences ere buned or dameged, I:a owner, will bc hcld re��nsihle md charged for snme
<br />i', Thni tlm MWD, iB alTicers end egenLs, shnll hevr Ihe nFM of mgrtss nnd egrcss In gn upnn Ihe prcmises end pr�crly descrihea herem fnr Ihe puqxrsr nf
<br />impecUnn, cnnnecung nr disconneclmF the servme nr im such olher purpnsa Rv Ihe sen ¢e mey rcqwrt. li is den w�deret�nd durmg the lime �hai my n(
<br />Ihe wmer mnins mny he mm �f serv¢e hy rcnsan nf eny emergenep nr imprncemems eW horizeJ h} Ihe MWD, in eny strce� nr uther Iocelron in wh¢h Ihe>
<br />me� hm�c heen IeiJ, �he MN'U will iwt bc reqwmA In fumuh wnler dunng Ihe pmpmza of such improvements Io nm con�umer whnse supph� me} lhus hc
<br />nrt n1f, nr be hehlc fnr en�� demeFcs (or itc (ndw< In da sa
<br />IN �, �I hm 'he MW U shnll heve Ihe nFht In changr Ihe nies et eny Gme hy RunlWian, ln mmpnnnl� discon;muc Ihe urvice In consumers, mid b inslall tlic
<br />mcle�ls) lo regisin Ihe wmu cansumed l he M WU shall nnl hc held liahle fnr demepe by weter m mher cause msullm6 fmm de(ecuve plumbmg or
<br />opph ances mstelled h) Ihe nwmer m nccupnnl nn �he premisa supp�ic., wnh wn�er, md �he (ect Ihm eRenLs o! he M W D mey heve mspecled �he plumhm��.
<br />unA nppliences shell not hc pleeJ u e hmis fnr rccnvery in cnsc nf dnmoFc n� nforeseiJ um� :���i>� �r wa�� ,n�i rn�i �� n� ��i�����a n>� «��� �r
<br />n¢idcnC Inw prccsum m alher eeuae whetsnevcr, lhe MR'U shnll nnl h< held Gehlc (or demeges nnr shnll sueh 6ilurc or mtertupunn fnr ony rtasnnnhlr mne
<br />h< hdd In ennxtiune n h¢edi nf cnnvect un Ifm pM of Ihe MN'D r m nn) w�ey rcheve Ihe mnsumer, wLelher irnenl or ownee !mm ptt(nrmmg lhc
<br />ohhFnlian nf such tenen:'S nr awnet's coNrncl N'eter shnil be useJ hy xpp6c�ni anly on Ihe prtmises descrihed herein A new epphuuon sNell Ac GIcC
<br />�hunld welr be dcvrcn fur nthn prcmrscn elthouFh IocauJ on land Jesc�ihcJ haein
<br />.- 1'h 1Lit Ihr hIN'II ra�nmmendc imullalinn of o prreeurr rr�nl�lin� v�We. Appllan� �rknnwlydRex Inform�lion u In Ihe remmmrnJ�lioa �nA
<br />u�umes lull.rnpondhlllly fnr InsUIGnF m fdllnF In Imldl � prtea�irr rrFul�llnC vdvt nn Iht w�ler sy�lem In prnleC II frnm hiQh
<br />' prtce�vr._( f9 1\"I.
<br />I llli Ihe IN\1�U utllim A�rrY rdrr� �I Ihr mrler in prrvrnl w�ler relarnin� la Ihr Pi�trirlc mdnR. 7'hr �1K'b rttnmmende Ine�dl�liun of � Ihermd
<br />r�p�minn I�nL In prer�nl tnnfivr prts�urr huIIJ�Up ru��rd hc Ihr M'�Itr ht��er. Applic�pl�{I`n"1^I, IKex Inlmm�linn u to Iht rernmmcndnuun
<br />u�A unimes full rrspaneibility fnr imldlin�; nr f�iling in inaall a Ihrrmd np�minn I�nA. l�_
<br />.�i-i:'rICIiAUDItISfi ���- i-•l!%�'�. �. "ll. I(�INU % Bl(x'K
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<br />nNRJf R ti NAMI . ��i�" �7� //,%�II / J [.L� l.f(iAI DCSCRIPTION: /�G ��[i .^ /�'!/.H' �,i_/I
<br />uWN4.R 5 AI)URI.Sti: Id,P' .,'?'/4j,^r�i�ti /.+^�_ �'_� u'� l�f ��
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<br />� irvnintr�zir .,"'r'_,. ---_rl.•� �at.ix� PGRMIT IStiUC:D AY
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<br />1Lcprenuscserclnhcuxcdnse____J�i___ _ WFORMATIONL[PfIiNOIVCN.______ ._ _ .. . -
<br />:_+! lt)'�C'L''I17'I SJlAR4Ii5.
<br />I kvdopet Incudled V 111 titrvice inslelleUnn 6 rnnnecunn ehnrge S__y ��� "� __
<br />UisuialnsldleA I:�(ienerelfeeililirseonneetmnehv@e S_��_�-_..._.
<br />Uislnct Inridled I�wm�•
<br />I 11 OILer � -
<br />1 otal emaum recerved wuh epplsetinn S ?� '�'�� .
<br />Il IS UNDG.Itti7'(N)U Ihel lhis Apphcauon, el�hnugh signed, shell noI be hmJmg u�m Ihe MUAILTC•O N'ATC:R I)ISTRICT until npproved h7 tha Ultii'Kle'"I
<br />I. Ihc w�dttsiened. nwne� U�r rcpmsemnt�vc) nf Ihr prnpenc descnhaJ ebnvc, du heieM1y mnke epp�icWon foi mslnlleunn nl n
<br />�orvlce canneUmp, including eppunenences, end nll necesseF- �alJuePt m� esMnses
<br />limedllns'____Jeynf_ �_..�'_L__.__'.._.__-_
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<br />'/t! -inch dinmeler w�tcr suppl�
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