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' �� MUI�ILTEO N'ATER DISTRICT
<br />APPWCATION FOR �V'ATGR
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<br />Me�cr Sizc: Scrvice Address: _ � __
<br />!dumbcro(Units: T
<br />'.lcicr will be uscd for (check all thet apply): 1�'_ _ Dom�stic __ Irrigntinn
<br />�«� N�. �.�3� I
<br />Firc Service Fire Line
<br />I hrrcM� appl� fnr wat�r strvice end npree tn be governcd, in nccordance with the resolutions, rvles und reguletions nf the MUF:ILTl:O N'A"ff.It
<br />1�IS7'R ICT (MN'D) peneining In wn�er servitt, nnu� nr heree�tr in rffect. The undersigned as owner ur represrntat�ve af thc herain-describcA
<br />pranucs herchp nprees us fnlloW�s
<br />11 i The cansumv eprta In install, nperele end memtun et ell umes, Ihelr plumhmg system m rnmplience wilh Ihe cunrnt edmon of tl¢ Umfartn Plumhing
<br />Cide ss it penems �n Ihe pm<mmn nf ennummeuon. enJ prnlecunn fmm Ihertnd expension duc lo e closed system Ihet enuld occur with Ihe pmseN o�
<br />futurc msullnunn a(beckllnw pmveNers nn Ihe consumer's serviu end/or e: plumhmg GMwes
<br />(L The eonsumer egrtes ro mstell ell beckllae� prtvenuon usembha requesicd hp ihe MWU. end tn memum �hme b¢kflau� prevemlon usembhes m gond
<br />wirkmg nrder 'he assemhhex shnll he n! e type, enc end meke �pprnved M Ihe MN9) md 1he Wsshington Stete Depenmrnt o(IIes1U Authant� The
<br />usemhhes shell be mslelled in nttnrdence witli ell slenderds esmhlisheA hy Ilm MWD
<br />p i The we1e� memr will nM he msulled umil o wamr use eurvcy hn� tmn xubmnted hy lhe epphcent enA Ihe D�stricu Crnss Cunnecuon Contml Spenehst hns
<br />deiermincA if Ihe custnmer will necJ �a msmil e hn:k0ow prevemer on Ihe cuslnmer'x side of Ihe meler.
<br />14 i Thnt 1he cnsl n( eny ezmnsirn� nllhe we�cr scrv¢e, rrnewel, rrplettment ar repnu In rcach end srne Ihe propettV deserilred shnll be Aome by mysclf or
<br />css�Rns u nwncqxl nf Ihc prcmiscs
<br />�s i Thet ell pipes, w�eter nien�unnF device+ anA o�hn connecurn eqwpmeN upslrcem fmm 0¢ mclu shnli, efler Ihcir msullaunn, M1c end hecnme Ihe prnpen� ol
<br />�hc MWD. suhlcct m ell iL� reguleunns pcnmmng In wemr scrvicc
<br />I��i Thnt aller mslalleunn, dme�er nr meler M�c enJ eppunenences nre buned ar Jemeged, the owner, will be hcld respnnsiFl<and chmged fnr snmc
<br />17I 17int Ihc M WU, nx olLcers end eFen�v, shr;l Imva Ihc riFhi of mgress end epress 1� pn upon ihc premiscs end pmpeny described hercm (ni thc purpnu al
<br />ms�xrUnn, cnnn¢�mq nr d�scannecUng Ihe :erv¢c nr for such nlher purposes ex Ihe scrvme mn} reqwrt. 11 is elsu undersl�d dunnF Ihr umc Ihal em� n!
<br />Ihe wamr mninx mnr Ire out nf eervme Fc tenann a! a�n' emergenc) nr impnrvements euthnnzed bc Ihe MR'D. in eny s1¢cl ar nlher Inenunn m which Ihe�
<br />mn� hav< heen laid, lhe MN'U w�ill nnl hc reqwrtd In fumish weter AannF Ilm pwpress of such imprnvemenls In nny consumer wLmr supply moc thus bc
<br />eW oR, nr hr ImMe lor nm Jmm�Fes fm iu ledurt In d: ,o
<br />IN i 'Iha Ihe MN'I � shall herc Ihe nµhl m chenRe �hc rales ei enq ume by Itnniution. ln mmporaril� discnnunuc I.ie semtt In cnnsumer�, nnd In mstnll thc
<br />meieqs) In rtgnter Ihc amer cnnaumed The MWI� ahell n�1 hc held �iehle fnr demngc Fy wmer m nther cause nsulunF fmm defecUve plumbm�: or
<br />npplinnces mslelleA h) Ihe mmer nr nccupnnt nn Ihe prcm�ses supphex with weler end �he fecllhet egenis al�lhe MWU mx} heve mspecleJ �he plumhm��
<br />and npphencn ehnll nm (x� pleeJ ns e hxsi. far rtcnvcn� in caae nf demn@c dc e(nrcseid �! tl¢ suppl) nf weler shell tnil nn c� iolcnupted hp reasnn uf
<br />ecudem, low prtssum or nlha cnuse uhelsneva, Il�v MR'U shnll nm bc heW liehlc fm dmm�ges nnr shnll such feilum or mletrupuon fn� eny rea�onahlc inn�
<br />bc Lcld Iu cnnsUmte n hunch of cnmrecl on Ihe pnn af Ihe MN'U ar m eny wey reheve �he cnnsumer, wheUer lenmu m owner, frnm perfotmmE Iha
<br />nhhpaunn nl such IcnnnYe ar awner's cnnlract Ketn shell be useJ h� epphcaN anl� nn We pmmisex JesaiheJ i¢rem A new� epphr.nuon fhell hc GIcJ
<br />s6aulA wetn ho dcsucA lur ntha prcmivcs nllhouFh Incolcd nn land dcscnbrd hcrcm
<br />pp Th�� Ihr DI\�'U rtcnmmrnd. Imtall�tlnn nf � prra+ive reCnlollnC vdrr. Applinnt uknnwlrJRn Infnrm�llan �x In Ihr rtcnmmrnddiun �nJ
<br />■eemm� fyll r(�pnnsilriliq' for In�mllln� nr faIIInF in fneUll a prre�urt rt4id�lin�; rdve an Iht w�trf rvflem �n prMrtl II Gom hiRh
<br />prt�enrt.�... ^'I 1��1.
<br />IIII� 7hr 1111PU ulihrn �Ivrk rr.lrr� oi Ihr mrlrr tu prove�� auler rrtnrnin; Iu Ihr IF�Irirn mdns. 7�hr �IWU rraommrnds Imldl�lfon nf � Ihermd
<br />tI�IPOflllp INOA IU rtHT01 flMiSlYI' �ItHqllf IIIIIIII-11�1 f�INf1I I�\ Illf KYIfY IIlI�fL Arllllf��l �{�4nnwledRcs fnform�lfnn u lu Iho rtmmmenJ�tinn
<br />�nJ �naunrts Inll rrepnmlhilln far insulGn{; nr fdlinF tn inaull u Ihrrmsl r�p�mian I�nk. _ P�,_ I\"I.
<br />til�.lt\'ICI�.AUUltftiti _ °�'�� � %"��� 1'. ,..�1. . . ItYI Nu . __ _ _ ___f1117CA _ _ _.,....
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<br />.. - .: I.1 (iAl DF'tiCRIPTION. ��(= i•u ,J/�i/� /:�.Z.! .=J.,' /. � .
<br />i�WNGR'SNAMI. ' � — .
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<br />��Ill"'tiTA':IS711' .� ,-~-- --- -.— 81.UGPIiItMf�ISSVEUflY�_ ---.- —_-.-----
<br />Ihr p¢miscs mc tn hr uccA n� a__ __�_r____ ____ _. INFOItMA?ION l.f.TTfR OIVF:N�.
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<br />Ikrdaperlm�ellyd __�_,__
<br />I h�inU InnallcJ _. ___ __
<br />I��annlnstnlledVulum ___.
<br />CLLABQCti_ � �7�
<br />(I ) Scrv¢r ms�nllauon 8 cnnnccunn cherpt S
<br />(?ICienerel Pecihues mm�ecUnn charge S `�� '_.
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<br />lntel emuum m••rvcd wilh epphcnunn S `/.:_ •"_� ..
<br />I! Iti 11NULRti'f1i;)U Ihet this Apphceunn, ellhnugh sipned, shell noi bc bmdmg upon Ihc MUF:II.7'PO N'A'IGR DISTRICT umil epprmcd L� ihr I �Iti Il:t� I
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<br />' ihc undenipned nwncr I��r rtprtsrnlnuccl ul IFe propem desenbed ehnve. An httehy mekt epphcmion fm mslnlleuon �( u_._
<br />�nvi<c cnnnecy�n, mcluding eppurtennncc+. nnJ ell necedxer�,u�u,.J m� arpensa
<br />' �,ueA Ihu '� An� o� � y� � _
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<br />4pphcnnCs Address � Phnnc Irumher . _ ____ __.__ ___ .� � Y ---
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