|
Y :
<br />MUKILTEO N'ATER DISTRICT
<br />APr^LICATION FOR N'ATER
<br />Mctcr Size: � �� � Service Address: ? ?�� r �`� �' (� ���' S' -J �
<br />� °Jumbr.r of Units:
<br />Meter will be used fnr (check ell thet epply): _'�_ Damestic __ Irtigation _ Fire Servtcc
<br />AaL No.:1Q_�� 9
<br />Firc Line
<br />I hereby eppl�� for wntor service and egree to tx govemed, in ecwrdance with �hc resolu�ions, rules end reguletions of the MUF:ILTEO N'ATI:R
<br />DIS772ICT (Mk'D) pennining �u weter service, naw or hercalter in el'fect. T7�e undersigned ss owner or rcprcsentntivc of �hc herein-AescribcA
<br />�rcmises htrcby eFrees ac follnws:
<br />( I I The cansumer egacs m ins�n!:, aperem end memtein ei dl times, Iheir plum6i�g syslem in camphence wiih �he cumm edlt�on ofthe Unifonn Plum6mg
<br />Gide ss It pertems �n the prcvcnhan of contnminetinn, and pralaGnn from lhermel expenfmn duc lo � clrned eyslem Ihot could occur wilh Ihe prcseni or
<br />futu¢ msielleuon of 6¢kliow pirvrnlers nn Ihc cansumer's scrvice enNnr et plum6mg Gwmrts.
<br />(=I The rnnsumcr egrees In inslnll ell beckOnx prevenuon uscmM1hes rcquated h}� Ihe MND, end to meinuin �ho�e beckllaw prcvenuon sssemh6a m F���d
<br />worting nrdcr Thc uscmhims shell he o! e typc, sin end mekc npprmcd Ny Ihc MWI1 end �hc Ws�hinglnn SWt Deperimen� of Hesllh Au�honty Thc
<br />e.asem6hes shell he inslellcA m eccorJenec with ell slenderds estehlisF..d hp thc MWD.
<br />(7 � Tho weter memi will not Ix msulled until e Meter usc survty hns been submrtted hy Ihe eppiicent nnd Ihe Disvicls Cross Connec�irn Conl•ol SpcnaL•a hus
<br />delermmcd if Ihc customcr will necd In insinil e beckllnw prevcmer nn lhc customer's sidc of 1hc meler.
<br />iA � Thnt �he cnsl uf miy atensinn nf Ihe wa�n scrvicq rtnewul, rqilnecmem or repeir in rrerh nnd sme ihe pmpe« y descriM1ed shell be 6ome by m� ;.d or
<br />ess��nc ns nwncrls) ��f Ihc prtmisc�
<br />( 5 i Thet ell pi�xs, wamr meesurmp. dev¢es end olher mnnecuon eqwpment upslream Gnm Ihe metor shell, aRer Ilxv ms�elleuon, 6e md hetnme Ihe pmpenr u!
<br />�he Mµ'U. sub�ect In all ils rtguleunns peneWng Io wnter serv¢c
<br />1(�I 'fhnt elier insulleunn, if macr or maer hox enA appunendses erc huricd nr demeged, Ihe ownet, will hc hcld rcsponsihle end cherged for same
<br />(� i Thet Ihc M WD, ns nRittrs end egenls, shell heve Ilm right of mgrcss end eprcss tn go u�wn Ihc pmmues nnd propehy ducriLed hercin fnr 1he purposc nf
<br />mspecUnn, cnnnecung or discnnnecling Ihe un�ice nr fnt such nlher putpnses sa Ihe scrv¢e mey reqwrz. II is alsn undentex�d dunng Ihc hn�c Ihnl em' nf
<br />Ihe waler mnins mey he nul nf scrvicc hy ¢nsnn nf eny emerRenev n� imprnvemrnLs euthnrv<d hy the M WD, m eny xtrtet or olher locaunn in wh¢h 1he)
<br />me� heve heen le�d, Ihe M WU wiil rnl Me rcqwted tn fumuh weter durinp �he pmgress of tuch impmvemenls lo eny amsumer whose supply mey thus hc
<br />cW aR, nn c� hnhlc fin eny demxpes fnr iLs (nilurc lo Jn sn
<br />(N i "Ih.r. Ihe M WU shnll hevr 11¢ nght In chenF' Ihe reles et nm� ume M� kaoluunn, lo mmporerily disconunue Ihe service tn ennsu�ners, end In mstall thc
<br />melcqs) �n rcgisln Ihc wnlc� cnnsumcd lhc M WU shell nnl hc held Imhlc (nr dnmegc b�� wetu ar nlher ceuse rtsullmg Gnm dcfeetivc plumbmg or
<br />nppliences inslelloJ hy Ihe ne�nrr nr ocn�pmm �n Ihe prtmiser. sunplies with waler, enJ Ih[ (ecl lhat egen6 ol�he M WU mey heve mspecled �he plumhinp
<br />qptl 11�1(IIIMCCS SM19II 110� I1C �IIC�d &\ ! Llib �of ttCOvtf1 10 C¢K O( (I0R111Ft et l�ORSeIA II� IIIC SU�1(II}' <�(N'Eltt SM1sII (BII Of hC III�[RL�Ifd hV ECt.aO O(
<br />ncndem, Inw p¢ssurt or nther ceuse wheb�xver. lhe M WD shn�'. not hc held hehle far dameges nor shell surh fuiWre or m�ertupunn !nr eny teesnnnhlc iunc
<br />he held Ia cnnstitulo e hreech nf <nmrnet on lhe pen of Ihe MK'G ar m mY e'ny rclievr Ihc rnnsumer, whelher tenent nr mmer, fmm �rcrfnrming Ihe
<br />nhhFalinn of such �rnenCs oi ox�ner's ��nntrecl. Wxm� shall hr useJ hy eppticml only nn lhe przmises descriheJ hercm A new applicauon shell be filed
<br />chuulA wmen c� JesircJ lirt niher prrmises ellhm�Fh loceted mi lend Jescribed hereln
<br />(9� l'lul lhr �IWP rernmmr,nJs Imtallniun nf � prre+nrr reQid�ling v�lre Applianl aMnnwlydRn Inform�lion �a ln Iha rrrnmmend�Nan �nd
<br />' nmmee fall rrepnnslyilfip fnr IneldllnF nr 6llin� in Ineuil a preeenrc rrCid�tin� r�lvr an Ihr wuer ey�lem In pmleel ll Gom hi�h
<br />pre�eurr.__ �',/�S1.
<br />(Ilq fhr MWII u�l Nee check vdrrs �I Ihr mrlrr lo prrvenl w�irr raWrninF In Ihe Ili�ldeb m�ins. 7'hr DiH'll reaommenda Imtdl�6nn of � ihermd
<br />np�mian I�nk in prrvrnl ac^+sirr prranvr 6ulld-up auud M� thr n�lrr hra�er. Appllnnl �rk edFrn Mfnrm�ifnn u/o Ihe remmmrnJiUnn
<br />•nd �ssumrs Gdl reepnndblliy� for imld11n4 nr fdlinx In Ine�dl � Ihermd ap�nalon t�nk _ IN7�•
<br />� i�l i� ,' l ' , I 1' i �/ .'l
<br />�� �i' ,� . �,, i � �. . IDTN�� ___7� (�LCH:V:— —_--_
<br />si itvit e nnuer:ss "y ----- --- -- �.` � �� � i�`
<br />c�lf1"tilA'il �%II' �.'� � . . PLATNAMF ` � —
<br />._ _i .. _; V_��-r-r--..___ : __..__ )
<br />i �N'VI�R'S NAA7i� �� � 'I � � `' !'� ! . � • LP.CiAL UI�SCNIPTION. __ —
<br />. _'.�J' � �,i •�./1�1 ,. r %�. � J..' I
<br />n1l'NIiR'ti AUDIiI'.Sti v_ —.__. ------
<br />�/1' rr
<br />� ii�,srnnnir _ ---- oi.ocw:kMn issurnnv ._.._ _ —_ _
<br />lhr p¢miscs mc la la uud as e
<br />CI It\'I47�_7]'f�;.
<br />I �crelaper Inatelled __V _
<br />Ih�inctlns�ellcJ _____.
<br />Ihtiinclln�IdlcJfmurt ____
<br />' ���F' INFORMATION..f:7l7iR (iIVPN: __ __
<br />�IlAfi(ifi� . ,
<br />.i,J-,
<br />( I 1 Service inslelleuon & connecuan chergr S_______ _ �
<br />R�(iencrelPeciiiuesamneawnchergc S. �� �._ -__ -
<br />(31Other f — —.
<br />lotel emnunt rccerved wnh epphcaUon s ~��/_ .. -
<br />I I IS IR�ULRtiTIAIP Ihm �his Apphcalinn, allhaup,h sipneJ, shell not hc hinJing uqm �hc MUKIISfiO N'ATCR DISTRICT unt-1 ��mcA h� ihc Dltilltl(��I
<br />I Oio undemRned owncr lnr rcp¢senleuvel nllhc propeny Aescnlxd ahnrc. dn henM� mekc npphcannn tor mnxllnban o( n_. _.__ �mch diemn<r x�vm� suppl�
<br />�rn�¢r cnnne[pnn, mcludmF epputtenences, nnd all necesseq� le6pul nn eapenses
<br />Ii,nrJtlus___—__Jnpnf=� � 4�" / = •�•..•�—
<br />� . __'.
<br />������,�:��,� S��;N�,�,H, ___ - - - - PAID
<br />4pI`I¢ml'x Nemr lPlrnse pnnll __�_ ' '
<br />-.__ _..____ _— —_ _._
<br />npphcenl's Addrns d Phnnc Ni �ber _ -� __ _ __.—� �---_---- �� r � �9
<br />i��ai�,t('c�NNh[..II��N('crti17tO1.5UMMAHI'ASSCSSMI'NTPACAPLU1YRIiQUIRGU''� NO /� %TJ D�J
<br />I�ponll�cncc . ____ tiimnflkvia ______ ('Ctilnitids Uatr. _ /
<br />I
<br />1YI'ROY . 1f1'AII:i-fON�ATGH111ti�1�R1('1
<br />� Unlc /%3/�09�7'
<br />H� _ . '.___ _--_
<br />MVUWD
<br />Issued H) _ �
<br />
|