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MUKILTEO N'ATER DISTRIC'f <br />i APPLICATION FOR N'ATGR <br />��, i✓�� �. .:r_l. <br />Metcr Size: '"^/U Service Address: �y �� ' � � <br />Rumber o` Units: —�— <br />Meter will be used (or (checA all that apply): __� Domestic __ Irrigation _ Fire Scrvice <br />Acct. No.: �� <br />Fire Line <br />1 hortbc epply (or water service end agrea m he gnvtmed. in nccnrdance with lhe rcsolutions, rules end roguletions af thc MUI:ILiTO WATER <br />UISTRIC7' (MN'D) panaining to wmer service, nn•x or hercufler in eRect. The undersigned ax owner or reprcsentative of the herein-described <br />premises hereby ngrees ae follows: <br />( I) The cnnsumer egrea In uulall, opente end mein[am et nll umes, �heu plumhing system m compGenw wilh the currcnt ediUon of �he Uni(orm Pluml mg <br />Code ss n penems In Ihc prcveminn of enmamineuon, end prmecUon frnm Ihermel exp�nsion dur to e chned sysmm �het eould acur wilh Ihe prcsrn� ur <br />fuWra ins�elleunn of heckOnw prcvenlen an Ihe ennsumer'x semce enNor al plumhing fixiutes <br />RI The moeumer egrtts lo msmll eIl hukOnw prcveNion esxemh6es requcxled hy �m M0.'D, end �n meminm lhnse beckllow prcvrntion assembhes m poad <br />wnAmg ordcr il�c essemhlies ehsll bc n( n ��pc. svic enJ mekc eppmvcd br Ihr MND end ihc N'nahinglon SUm Depwnmt of Hallh Aulhonty Thc <br />dtvcmFhu shell bc inslellcA in eccnrdencc wllh ell stenderd+ cslnbhshcd hc Ihc M� <br />(1 � The weler me�er will nm Me mqelled unlil o weler use survry� hsc 6cen suhmitled M1y Ihe epphcW md Ihe Disincla Cmss ConnecGon Canitol Specmlisi hns <br />de�armined if Ihe eutlomer will need tn ms�all e backOna prcvrnter nn Ihe euslomer'c side nf Ihe meler. <br />(4 � Thet Ihe cnsi nf .my eKmnsion a(Ih< weter urvice, renewal, rtplecemenl ar repair �n rt�ch anA scrve Ihe prnperty desenMd Shell be hnme by myself n! <br />assiFns as oxncrlsl nf Ihc premuec <br />(51 Thel dl pqres, a�nler memm�nF dev¢es enJ other eonnecuan eqwpment upstreeci frnm Ihe meia shnll, e11er Iheir mstalleUnn, he end heenme th^ propeny ol <br />Ihe MW'D, suhlen In ell i�c rc@nlounro penemmg In wetcr serv¢c <br />1(�1 7hn dler inslnll�uun, �f inete� nr mae boz u�d epputlenunces em huneJ or demnged, Ihe nwner, will he held rcspnnsible end cherged far seme <br />(' � lhn 0¢ MWD, ils olf¢ers nnd eprnts, shell hevc thc �iRht nl inFrcsc enA egmss lo po u�an Ihc prcmises ena prererty describcd hcrcm for Ihe purpnsc el <br />mspechnn, connecUnF nr Jisconnatmg Ihe scrcice ar fnr such nllmr pntpases s� Ihe semx mer reqwre II �s elso underst�wd dunng Ihe time �hat enp o� <br />Ihe weler mmns mo7� he nul n(servmc hy renanu n( eny emagency or impmvemenls emlonied hy Ihe MWD, in eny strttl nr mher Incauon in which Ihc� <br />mnc hav: heen leid, lhe M WU will nnl be rcqwmJ In fumnh weler dunng the prngrcss d such impmvemenu lo eny consumer whnse supply mey Ihus Lc <br />cut nR. nn c� 6eblc fnr em� AemeFes !ar rts IniWrc In dn sn <br />(N � "I hni Ihe MR'U shell hnve �hc riFht In cheng< Ihe reles ai nnr time by Hesahmm�, tn Icmponrily Jrscanunuc Ihe smiu In ennsumers, md lo instell Ih� <br />me¢qsl ��+ regisler Ihe wmer ennsumed Thc MR'U shall nnt hc held Imhle fnr demagc hy weler nr nlher ceuxe reeulung fmm defecuve plumhing ar <br />apphenas mslnllcd hy Ihc nwncr nr occupent nn Ihe pamrses supphes wnh wetor. end Ihe fect Ihnl nFen6 o(lhc MWD mey hevc mfpected Uir plumhmp. <br />nnd npphenca shall nnt M1c picnd d� s 6nus fnr rccaven� in cntt af dameFc as efnreseid if the supply af weter shell feit nr be imertupleU by rcunn a( <br />acndml Inv� pressurc nr nlher cnusc ehnts�xver. Ihe MN'D xhnll nm hc held hehle (or Jemeges nnr shell sucl� fnilure nr mlerrup0on f^r eny ¢a�nnnM1lc nmc <br />bc hr!J In ennsulu�e e hmech nf cnmrecl on Ihe pnn o(Ihe MH'P ur in eny wo� rehe� c Ihe ennsumer, Hhclher Icnenl nr nwner, fmm pednrming tl¢ <br />n�diFaunn of xuch Icnenl3 m nwne's cnmrect �1�alei shell he uved h) eppLcmt onh on Ihe prtmisn described hercm A new app6cetinn shnll hc GIcJ <br />xlinutd xmer h: JesirtA fnr nlhcr prcmnes nhhnugh Incnled nn land JexeriheA hcrnn <br />(4� �lhn Ihr M�1'1� rrcnmmrnd� Ineull�tlon nf � prneurr reFulalinC vdve. Applinm aknonl�JRn Inform�llnn �s In �hr recnmmend�llnn �nd <br />unnmrs fuU.rnpnmiblliry fnr ImmllinC nr fallinC In In�tdl � prr��urr rrCul�lin� rdrr on Ihr water.ry�lem tn prmrct It fmm hf�h <br />pree�urr. _ _ 1\I. <br />(Ilry 'I�Lr N\Pp ulllirrs rhrrk ��dvn u Ihr mrlrr In prrrml wmrr rt�nrnin� In Ihr Ilietricts m�ins. 7�hr MN'P rrcommends Imtdl�tion nf � Ihrrmd <br />e�pun�ion I�nk la prevenl rirce+ire prr+mrr build�np rnieeJ hc ihr x��cr hrx�re Applfe��1xlmnwledQes Infnrm�lion �s In Ihe rrcommenJ�linn <br />■nd ucnmr� Gdl rafonslbiliq fnr inalellmC nr 611inC lo Inetdl u Ihcrmd np�mian I�nL _ INI�. <br />�7' ,%%���� ��. '��, � <br />SFRV('I A1111N1titi .- . _ "��T I1L(X'K__._ __ _ _. _ . <br />._j�.'-_ .-s__..y. ^`. �. __—.. I'LATN,AMh: � I.�i-:.�✓. �� i�i'� <br />('I I Y'lSTATI�!!II � --_— / ��—T�'T .'— o / � <br />..:..�u�/. `�( LC4ALUISCkIPTION�.—�— ���^�.� <br />r� <br />UWNI:H'S NAM6. � <br />—�— 7.✓!% ".^,nn�i�'� 4_ r',fl�/ /4'.G c/E.'�1� h'', :% <br />t7WNIiH'SADDR[tiS._____ � ------- —.. <br />-/, � /r`�.-- [iLDGPIiRMI71StiUfURY' -. <br />Cf1�1'/ti1�A'I-L!/.II' ' . � _� _ — .. <br />J WFORMATION LF:'ITI[R GNGN <br />"I l�c p¢mnes art la he Uxd u e_ ___.— . --� —� .. <br />sitt���Lt�tu�:_ �tnttclt:ti 35/ ✓� <br />I7evclo�xi Insulled v (I 1 tiervia mslnllelmn i m�necuon chnr�e S :: ',,. - <br />I hsV¢t Inslellad _____ RI �ienernl fecihues connecuon charge s __— - <br />IAsmct Inclelicd Pumrc UI �1�mr f <br />'I mel emount rccavcd u�i�h epplmaliun S—_� ��T-�. <br />ff Iti I MDIiRtiTOOD �he� Ihis App6ceuon, ellhnugh signcJ, shell nm hc bmdmg uqm Ihc MUF:II l'Ii0 N'ATGIt UIS7RICT until e pmvcd bq Ihc DItiTRIC I <br />_=r�, ���n <br />I, Ihc unJersiRnvJ. oenu I��r rcprcunlntrvel nf Ihe prnp<m d=ccnFrd ehovc, Jn herchy mekr nppheNinn for im�allalion af n_____ -�nch dumeler c � <br />xcrvitt cnnnecuap; mcluJmg eppunennn�es, nnJ ell necessnr�la6�i�a m� expensa <br />, , , aus � e oy <br />I �nted Ihrs __ __ dey nl . .. __' _.. .. _' ' '.-- - — <br />41'PIIi��N"1�'S16NA'fURP..�_ ____ _____ -�_--___._—. -- -- - MWWD <br />��p�di. �ml's Nunc (pleesr priml ._ __'___ " . . •• - . <br />4pph.�nn1's AAJress & P6nnc Numbcr � _ - <br />� I;� ��'t Iv1NNP.(TI(�N ('(1NTR(tl tiI IMMARI' ASSIi55MFNT f1ACAPLON� RfqIIIRGD° X NO ¢���,.� <br />I�pr�dl)cruc _._. __ tivrnllkvicc ______ CCSIniGds _ Ue1c <br />AI•1'RO1' �/ D1D611 �fCU N�A'I'f:H IIItiTNI('I <br />��(�� <br />I�� _ <br />/ . <br />Ua�v _ ���/�OO� IseuedPy _ _.r- <br />