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AIUKILTEO N'ATER DISTRICT <br />APPLICATION fOR q'pTGR <br />MelerSize�. -' �� ScrviccAddress: �a'�•�'� �'��% /��• � rl. � <br />NumberofUnits: '— � ___ Acct.Alo.:�Q_�_� <br />T - <br />� Yvleter will be usad �or (che.k ell diai epply): V_ Domestic _ �R�Sation _ Fire Service Firc Line <br />1 heroM� apply for weter service end egrcc �o hc govemed, in eccordonco with the resnlutions, rules end reguletions of �he MUKILTEO WATGR <br />DIS71<ICT (MWD) pcnainmg �n weter stn•ice, nnw rn hercnller in effecL The undersigned es owner o� reprcsenlativc of Ihc herein-doscrihad <br />premiscs hcrrAy agrcas ac fnllnws�, <br />( I 1 The umsumer egrces In inslell, nperele anA maimem n ell limes. Ihev plum6mF �Ys�em in complienec wilh the curtent edrtian of Ihc Unifurm Plumbmk <br />CoAc na n peneuRlo Ihe prcvenunn o! cnnlemmauon, end prnlection (rom rhermxl e�pension due In u dnseJ system tlnl could ocwr wi�h Ihe p¢sem rn <br />future mstnlleuan nf heckllna prcveNen on Ihe comumer's scrv�tt pnA/nr �1 plumhmg fiztures <br />(2/ Tha cansumer eFrttx 1u inslell ell heck�aw prevenuon AceemLl¢s requesmd h} Ihe M WD, end In meime�n Ihnse beck0ox� prcvrnlion assemhhes m gond <br />workmg nrder Thc nasomhGee sha�l hc u!e �ypc, svic end meke epprmed hp Ihc MWU end Ihe Wnshmgton Slam [kpenment o( Hcelth Aulhont} Thc <br />usamhhes shell he inqeiled m nccmdenec wilh ell standerds eqehhahed Ae Ihr M WD <br />U I ihc wn1e� mcicr uill nm be mxtallrA unlil e weier use survey hes been sutmuticd hy Ihe eppl¢ant �nd Ihc U�slncis Cross Connccuon Conlrol Specielist hAi <br />dclermmeJ if Ihe customer a�ill necd In msle�l e heckllow prevenler nn Ihe cusimmer's slde of �he meler. <br />I�! i 17im �hr cnsl nl em� crlenswn n( Ihe w�ele� serv�ce, �rnewal, replacemem or repnv m reach end scrve 1he propenr deferihed shet� be bomr hy myeelf m <br />ass iFns a� nwmer(sl ollhc prcmisc� <br />' S i "I�hm nll py+es. weler meavunng da�¢es end ntlur connecunn eqmpmtm upstrcem finm the meler shell. e0er Iheu mstelleuon, he end lrec�me the prnpenv nl <br />Ihr MU�U, SIIIIJCCI IO flII Ilt R�!IIIpIl011i �ICfI01p10�' l0 N'GICf StNICt <br />I��i "I lint elter msla�leunn. d mcier nr mcter bnK end eppuncnnnces ere buned m damnped, thc owuer, will hc h<Id ¢sMmsiblc and che,gcd !nr samc <br />Ch 7Lnt Ihe MWU, iLv nfGcers end eFenls, shall heve Ihe nght of mgmss end egrtss in gn upon Ihe premise¢ enJ property descrihed hertm for Ihe pirpou of <br />in�peclion, ennnecung m uiscannecling Ihe scrvice nr (nr such nther purpoces n� Ihe service mn�� reqwre h is elsa unJerst�nd during Ihe Ume Ihel em af <br />Ihc xeler memx mny IK oul n! sen�¢c hy renvnn nf am emergenq� or imprnvemrnts eulhnnred F}� the M WD, in nny slrtti nr nlher laceUan m wh¢h Ihe� <br />mny hovc Ireen Imd, Ihc MR'U will noi Ac rcywrcA In (umish wel<r dunnF Ihc progress u! such imrynrcmems In oc i consumer whosc suppl�� mny thu+ he <br />❑n nQ m bc heMc fnr am� Aemx�cs lirr n+ leilum �n do so � <br />� N i 1 hnt the A1WU shell hnve Ihe n�:hl h� dmnfc thc retes e1 nny lime by Resoluhnn. m iemparenl� Aacnnumir Ihe scrvice In cansumets, md In mstall �hc <br />�����«Isl �n icgisln Ihc wmu cnnxumrA Ihc MN'I) shull na� bc hcld hnhlc for demngc bp wnla nr mhcr ceusc resuhmg finm AckUrvc plumbmg m <br />xpphencn inqnlled hp Ihe mrnvr rn uttupnnl on Ihe prem��es supplin wi�h a•aler, end Ihe fecl Ihet agenLv of Ihe MN'U mny have mspected Ihe plumbing <br />anA epplinncn shell not be plreA n� e havis liir rccoveq� in ense uf Aemepe ns alnreseid if the supply of weler shell fei! or be mlenup�ed by mason of <br />ncciJcni, Inw presxurc m nlhcr cnusr whe!s�rcvcr, Ihc A1V �U shell nn1 Ac hcld liehk (ur demegcs nm shell such fuilurc nr �mcrrup�mn for nn� rccsnnnhlc Wn<� <br />hc hqA Iu conanulc n hrrnch o! cnmrac� on Ihe pen of Ihe MWU m tn xnv wey rcGevr Ihe ennsumer, Nhelher �enmi nr nwner, Rom perfnrmtn�• �he <br />uhhFn�um nl sud� IrnMi'.� rn nwnn'+ cnnifAct N'Mr shell he used bg epplmeni o�,ly on the prcmises JucnheJ herem A new� appliceunn shall hc Gln! <br />shnulA wmrr Lo Ac.urd lin mh;r prcnuscs ahhnuFh IncnicJ on innd dcscnhcd hcrnn <br />I�I 'I h�l Ihe !NN'U rrrummrnAr imfdl�linn nta prnm;. �eFel�linR cdvr. AppHram �cknnwledRrs Infnrm�tion n lo IM1r rrrnmmend�liun �nd <br />■��umn G�II rnp��neihihlc fnr Ineldling ur f�IlinC �u In�Idl � prrs�urr rr�ul�lin�; vulvc nn Ihr w�trr erelcm tn pmtrol ll from hl�h <br />prr�airr. /. • 117�. <br />(101 �Phr MH'D nliliia chrrA r�lrea �I ihr mrler in prevenl n��lrr rrlurnin� lu Ihr Iliqrirls malns. 1'ha �fl5'll rtrnmmrndr Insldlation n!o thrrmd <br />rtpnneinn unA lu prtrrnl r�rceeiee pn�avo Iwi�d.up nueed br Ihr H�irr hr�trr. Applic�nf �tMnnwlyd�e. inlormuian �. In thr rrcaimnrnAumn <br />unJ ��xnmrt full rnpnnaiblliy� fnr iwdllln� ar hilin� In inaull � Iherm�t npensinn I�nk� �' IK'I, <br />siit�iri nnuurtis �t/� �� % � ,�' _ r/ — <br />_— . . . . . ._ . _. LOT NU _� _ ___ _ ffL(A'A <br />��I!1:'ti1�AT1 Tl1 K�'..��� � '�� . . <br />..--_ '.'_ �' - __.._. IIATNAMIi <br />� iN'Nb:R'S NAMI� • �. �' . � ._-- � _ �."_ <br />_ — — --- _ i eont rnsckir�iouNj ��l'N'o:t A7%i E5%f /N9:. <br />i����vF:R•Sn1�DRfSS —_�_ [.rc c.,R..� � �,.T - r � /J� �_--77'--- - <br />�Ill"SfA:'1=iZ11'____ t•�•: .'�'� --��� IfI.U(iPFItMITI55U1'.f)Bl'. -- <br />I Iv prriniscs em �o IK uced ac � `-� �h __ INP(/1iMAllON LLi'fliR CiNGN. <br />ti I I; \'il_'Ii1 L"L'Iz <br />Un clupa Insteilcd V � <br />Ih�inctlnstnllrJ — <br />i n�ti :t InxtelleJ Pulum _ . _ ___ <br />CI InItGl:ti. <br />( I 1 Servicc roslnllaunn d cnnncctinn rhergc <br />(21(icneral Feciltlms cannrnion chnrgc <br />(JI Uther <br />Tmnl mm�uN rreerved wuh eppliunnn <br />S <br />S �� . <br />S � <br />S ___ <br />I I I`, I �NUIiRti I( N1U Ihe� ihu ApphcnUnn. ahhauph signed. ehell �o� Fe hmdmg upon �he MUl:II.TFO H'ATI:R DISIRICT unul epprnved 6� tlic I71S112It �1 <br />I ih�� unders�pneA. nx�nrr �oi reprcsenlaurcl nl Ihr pnrymn7 desrnhed eFnve, da herth� m�ke epplicelion for inslell�unn o!a -inch dinm<ier Hairr suppl� <br />•� i� u c iunncU�nq mcluJing eppunenuues� nnJ ell natssen �nb�v�nt mv etpenees -- <br />I i.urd �6i� Jm of ' <br />1!`Illl'AN'fS�SI(iNAI'llkll _.`__ / �.. _�_ ___ ' PAIU <br />4�q,lc�ml'sNamclPlcwmprmil �,t'__ .f..• �:r.Aw:.n�� .. <br />4�q�li,:nnl's AAdress & Phnnc Numbcr _ __ ______.__ __ . _. _ _ __ . ... APR � 7 08 <br />cRutis�'�1NNII�'ll(7N(Yih'I'R�ll tiIR.1AtAR1'ASSIiStiMEMBACF:PLON'I:F:QUIRIiD1.__�1'F.5 _ X NO� MWWD <br />7 �pi� ��I lhuce . . . . _ tiire n(IXriee _ CCS Initiels � Datt � U� <br />AI'I'HUPI�I/� MI�BI .. <br />IJ k.0 \V A I I.H tHS7R1(9 <br />i�� `/`�7�-� _ i�e�� _ � o.oai '� <br />�ssuen �n ' <br />i: r �Lo..s �rh ��/c r /��?�i�rn !.� .t.Fa. l��w-/oD� <br />