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MUKILTEO N'AT�R DISTRICT
<br />APPLICATION FOR N'ATGR
<br />M�ier Sizc� �/�� Scrvicc Address� ��'�� ��� l�� "�� "� �� �'
<br />Number nf Units y
<br />Me[er w�ill be used for (check all that npplyl: ✓__ Domestic _ Irrigation __
<br />Firc Scrvice
<br />Acct. No.: �_��1_,
<br />Firc Line
<br />I herehp epply far wamr service nnd aErco to ba govemed, in ncrordenca wilh the rtsnlminns, rules nnd reFulmions of Ihe MIJF:ILTF.O N'ATCR
<br />UISTRICT (MN�D) peneining �n weter sen�icc, now nr hercafler in effect. Tltc undersiFned ns nu�icr nr represcntntive of the hercin-describcd
<br />premisos hereby ogrees es follnws
<br />( I) The cnnsumer egrces In instnll, nperete enJ mmNein et sIl umes, Ihec plumbmg xyxlem m camphencc wnh Ihe curtem ednion of Ihc llndmm Plumhmg
<br />Code nc il pemm�s in ihe prcvenlion of camommuuon, md p�olectwn !mm Ihermel eMpensinn duv tn e clnsed xyslem thet cau�d �:cur wilh Ihe prtsent or
<br />finua msulleuon nf bnckllnw� prcvrnlen nn U¢ consumrYs service endnrt nt plumhmp fixturts
<br />(-' 1 "fhe eonsumer egrtts 1u ms�ell ell backOnw prcventinn dwemblics rcquesled bc Ihe MR`U, end In mmnlun ihof- LncAOou� prcvenuon sssemM16es in pnod
<br />xrorV:mF nrder 71¢ assemhhes shnll he n! e type, sim end meke eppmved Fc Ihc MN7l end Lhe Wdahingt�m S�ale Deperunent nf Heallh Aulhonry Thc
<br />usemhlics shell he intlallcA in ecmrdenec with ell smnduJs estebLsheJ he Ihe M Wt1
<br />(! 1 The wo�er meter w�ll nnt be mx�elled umil n w�eier use surver has Ircen suhmiueA hy the epplmenl end Ihe Drstncu Cross Conneclion Conlml Spenehst hnv
<br />determmcA illhe cuanmer will nrcA In msmil e FeckOaw p¢vrnmr nn ihe customer'• siJr nf Ihe meler. '
<br />14 r Thn: ihr cnst n( em exicnnnn af 1hc wnmr scrv¢c, rcnewel, replettmem nr repeu lo rtach enJ sme Ihr propen� drscnlxJ shell Ac M�mc by myself o�
<br />tissigm as nxmcrlsl nhhc p¢miscs
<br />15 i Thet ell p�pes, wettt monvunng Aev¢es nnA ulhe cnnna�inn cywpmem upnrrnm frnm Ihe mem� shnll, e(Icr II¢u mstelieuon, be end Aecnme Ihe prnpem� nl
<br />Ibc MN'P, suhleci In ell us rtEulelinns pcnemmE In waler scrv¢c
<br />p� � lhn; eller ins�allnlmn, if ineter sr m<Ier Irnx end eppunenences erc hunW nr dnmeged, Ihe awner, wlll M1c hcld tespnnsihic end cherged fur semc
<br />(' i Ilini tlm MN'D. ns oflicers end �Fenls, shell heve Iht nghi of mFrcss enA egress In gn upnn Ihe premius end prnpem described hertm for Ihe purpase n!
<br />incpcclmn, eonnerlmg m discnnnecUng Ihe serv¢c nr (nt such nthv purpnxex nc Ihe serv¢e me) rcyuve h is elso underslnnd dunnF �he �ime Ihei mm �l
<br />ihc weter moms mn� he nm af sm�me br reacon of em� emerFency nr improvemenu eulhanxd h} Ihc �1N'U, m em xlrect ur nlher Inr.nunn m uh¢h Ihe�
<br />nun hxvc heen Inid, �he MN'I � will nnl hc reymmd In fumrch weler dunnF 11'.c pmpress o( such reiprnvemenu In any consumer whns sup��lc moq ihus bc
<br />�m n11�. nn c� hnMc fnr nny demaga fnr u�nilu¢ In dn xn
<br />�H i 7 hni Ihc MR'U shnll hnvc Ihc nght In clmnge U¢ rmes nI em Im¢ hp Itesnlnuon, lu Iempomnly dir:nminuc the scrvice In cnnsmners, nnd In mslnll ih��
<br />mcmrls) m rep�sler Ihc wnmr cnucumcA T7 e1N'l l shell not hc hcld Imbk inr AuneFc by welcr or nlher ause « sulunF lrnm de(ecuve plumhmg nr
<br />!r(fI1LIC6 Ifls�flll[A b\' IIIC aWil.� �f OCCO�EIII 1111 �IC �IfN1115t5 511�1�1II[S KI1�1 WEIfI, !OA IIIC IGCI II18I IICCOIf pI1hC �� WU IIiA)' IIpVC IOS�ItLICA IIIC �Illlfllblfl�
<br />anA apphences shnll nm bc plceJ n� n haus for recmcn m cazc nf Jnmugc aa eliircsaid il �hc supply nf w�emr shall fuil ar bc mierrup�eJ b} reasun nl
<br />acaJcnL Inw� pmssurc or ntlmr cnuvc uhetu¢ver, lhc MN'U xhnll nnt bc hdd LaMc (or ilemeNcs nnr shell sud� leilurc or mtcnupbnn fnr em� ¢s nnxMv innr
<br />hc hcld In cnnslmne u hi.ndi u( cnmroct nn the pen of Ihe M WD m in em wny rcheve Ihe cansumer, whelher Ienent or nwner, (nim pedarming �hc
<br />nhhEnnnn of such tena�ft m ounn's camreq. N'emr shell be useJ hy npphce�n nnlc an Ihe premises describeJ herem A new epphcauon shell hc lilcu
<br />shoulJ xoter he Jesirtd Grt alher pnmises ohhouFh IncaleJ nn lend descnbed herem
<br />pq Thu Ihv �IN'D rtcnmmends Im�dlalinn nf � preeenre rry!iduln� v�Wr. Applir�n� �eknnwlrJCrs inlorm�liun �s In Ihe rrramn.end�tlnn �ad
<br />uxu.nes full rrspunaihilin fnr In�tallinF nr 611in� �u Infbll e prc�surr rr�!ul�tin� rdvr nn Ihr wtlrr �y�tem In prn�ecl ll 6nm hiRh
<br />prrunrr. 1�'I .
<br />(���I lhr MN'll vlilurs ehrrk ralen at Ita mrlrr �a prrrrm h�atrr rrmrmnC lu Ihr Ilislrfck m�ina. Thr MWU nrnmmrnA� Imull�lion nl � Iherm�l
<br />r�p�minn unA In prewnl rvr�iivr prremrr Imild�up ninrd M� Ihr e�al�r hrurr. Applianl �eMnowladFa infnrm�tian u m Ih� rtcnmmenJuinn
<br />�nA n�nmr. Gdl reepan�i6ilin fnr m.ullin�; nr I�ilinR tu ine�dl u Ihrrmd npanslnn I�nk.�_. _ IN7�.
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<br />�I hc prtmises m In Irc used sa e_ `' r
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<br />LGGALUI:SCNIPTION JL' u'�/
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<br />rii.uc reeMiT issur:�� n�
<br />----- —__- - INPURMATION LGTT[R OIVIiN'.
<br />S:1lAASiI:S.
<br />(I I ticma �nsulleuon b wnneqion chergc S `" ��� ^
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<br />R�(ienerell'ecillliesconnectioncherge S_ � _
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<br />lmal omaum rccaved wnh epphcuion S_ ____ .
<br />Iti I�NUi92ti"f(N1I� Ihei Ihn Apphceu�m, ehhnuFh signeJ, shnll nm hc bmdmg upnn Ihc MUI:ILTHO N'ATER UISTIiICf umil oppmvcJ M ihc IiISIIUc'1
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<br />I. thc widcrnpncJ, nwnu �nr reprtsenlaurq nl Ihc prapenp des:nbed ebove, dn hercM1}� mnAe epplicdion fo� �nvlellsuon nf e___
<br />�a� i�r cnnp�j'e�includinF eppurlenenca, nnd ell neecssn�, Wqr�l my erpenset
<br />I �:mJ Iln�/� dey of _(__' _ __ _
<br />41'PI 0.'AN7'S' SI(iNATUlB` . ." •....—� "���
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<br />4pPhcnm's Name (plrxcc pmnl ' ' �� � � " .
<br />4�qdicnnCs Addras k 1'hunr Numhcr _ �� __
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