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hiU61LTF.0 WATER UISTRICT <br />APPLICATION FOR 1�'ATGR <br />:=/. '� <br />Mctcr Size� �-�`� Servi�c Address .T�_-.r ' � � ' �� -���-� <br />NumbcrofUnits / <br />�'Meter will bc uscd f�r (check ell that epply): �' Domestic _ Irrigetinn _ Firc Service <br />Acct. No.: ���_1 Z <br />Fitt Line <br />1 herebr epplc fnr wemr service end agrec to he gavemed, in ettordence with !he resolwinns ru�ts end regulstions o(the MUF:ILT80 R'ATFH <br />DISI'RICT (MN'D) pertnining m wetar scrvica nox� or hercniler in effect. 'f7ie undersignad es owner or represrntetive of thc herein-dacribed <br />premaos hereby ugrecs as fallnws�. <br />! I 1 The ennsumer nprccs In mstall, npereLL end meimem el eil umes, Iheh plumbmg system m cmmph�nee wi�h Ihe current edWon of ihe UNform PlumbmE. <br />CoAe e.v u penems In Ihe prrventinn of enntnmmeunn, end pmlecuon fmm Ilmrmel eKpenvnn due In e cloecd xytlem ihel muld occur wuh 11¢ present or <br />fuWre mstelleuan af b�eklloa prevenlers an Ihe cnnsumer's servme enJ/nr el plumbmg GtNres <br />(: � The ennsumer qtrces tn insull ell beckflow prevrntinn usemhhes requeeted M� Ihe Ml5'D, end to memtem lhose beck0ox prevenuon avsembha m guoJ <br />x�o.kmg nrder 'fhe sssemhlms shell he of e �ypc, snc nnA meke epprnved h� �he MR'I) end the Wdchingtnn Sum fkputmem af Halth Aulhonly Thc <br />ivemMl¢s shell be instelleA in eccnrdance whh ell s�nnderds esmhlished h)� lhe M�V'D. <br />i t i 'fLe asltt meler will nn1 Ix installed unlil e weter u¢ survcy hd� been suhmnmd hy Ihe �pphant end 1he DistricLc Cmss Cannecunn Cantral Speciehsi he� <br />dnermmcA i(Ihe nrslnmer will nttd �o mstall e heckOnw prerenler on Ihe cuxlnmtt's side of the meter. <br />I1 i TLxt Ihr rnst o(em cHlcnvnn of Ihe wemr serv¢c, rtnewal, rcpinccmcnl nr rcpmr In ¢ech end eervc Ihc properry� dactihed shell bc bamt by mysclf m <br />saxiRns e. mmerlsl ���Ihc premises <br />� t � Thei dl pipes, weler messunnF devices end olher connecuon eywpmem ups�rcem frrnn Ihe meler xhell, eller theu mstalleuon, he nnd hecame Ihe pioperry uf <br />Ihe MWb, sub�ecl tn ell av ¢gnlniinns penemmg lu water serv¢e <br />1(� i 'Phet e0er mslalleunn, if ineltt nr meler Anx end eppunenences ert huned or dameged, 1he nwner, wil I hc held responsihle end cherged for semc <br />111 l�hei tlm MW:1, its nlGcers end �Fenu, shell heve Ihc ngM nf mprcu end egrcss In gn upnn Ihc prcmises md pmpenc deuriM1ed hercm (nt Uic purpasr nf <br />inspr.nion. connectinF nr Jiscanneeimg Ihe sarv¢e nr Im such othcr pur(w�sa ss Ihc serv¢e mny rcquire It Is dxn undcntcwd during the �ime ihe� em nf <br />I�I[ R'BIC! IIIp10[ IIIB)' hC 0111 O�SfNILt h) ICASOp 0( CM't111CfFCI1C� Of 1lII�IIOVGIIIt015 80Ih0lVC� h\� lh[ �vi�i�n. 111 NY SQttI Ot Olhff �OCHb0010 WhIC�I l�ld <br />� mm hnvc heen leid, Ibe MR'U rull nrn hc rcquucA In Pomish wamr durin f Ihe prnFmxs af su<h improvemenis tn eny eonsumer whose supplr mey ihus bc <br />cu1 oR, nr bc linhlc for eny dmm�Fcs (nr ns fxilurc In da sn <br />1Ni Thm tl¢ M W I) xhnll hmx Ihe nFhi tu chenRe Ihc rnles et my lime hy Itesnluuan. �o Irmpnranly dixaminue Ihe serv�ec lo ennsumers, end In mstall lhc <br />mctnlslln ¢gislcr Ihc welcr consumcd 'fhc MN�II shell nm hc hcld lieblc fnr demegc hy wmcr nr o0¢r ceuse rcsulung from dcfcctrvc plumM1mg or <br />xppl�ences mslelkA h� Ihe nanrr nr occupnnl nn Ihe prcmises supplics wilh we�er, end Ihe fac� Ihat egenLs nf Ihe MR'U mer hme mspened the plumhing �� <br />anA xppliencea shell not 6c plenJ u a hasu fnr recnren� m cnce nf dxmope n+ n(urtsaid II II¢ supply nf w�ler shall faJ nr be mlenupted h} rcmon nf <br />xadent, law prnsurc rn olher cnuse whn�xnever, ll¢ MN'D shnll nnl bc hclJ IinM1k (nr dmieges nnr shell such fudu¢ nr mletrupuon fnr eny ¢asnnnMc timr <br />hc hdA �-� con+luulc e hmech ol amvncl on ihc pen a(Ihe M WD or in anp aur mhevc Ihc cnnsumer, whelher tenent nr aNner. Gnm perform�ng fhc <br />ahlipeu m of sud� IenenYs nr mvner�s cumrect N�vmr shell he uxeJ hy epphcant nnly an Ihe prcmises descnlred herem A OtN II�I�IIICL11011 SM1OII IV fded <br />ehnulA xmer he Jevmd loi nlher premiset ollhnuFli IucaleJ nn land descnFeJ hernn <br />1'h 1 h�l lhr 111N'D rtrnmmrnJ. inslwll�unn of � prnxure rry;nlning valvr. Applinnt aknnwlydRn Infnrm�llan n In Ihr rttammcnd�0on �nd <br />■numa fu�l rffpnnsibllit� (nr Imullin4 ur fdlin¢ lu Inr�oll a prrseurr re4ul�tlnF vdvr on Ihe w�ler rv�tem In prmrct I� irnm hiRh <br />preseure. � �' IR7. <br />(IIp fhr MN'17 utllins rhrrk rnlvre u Ihr mrter tu prtrrnl n�ner rclurninF Iu Ihr Ui�triris mdna. The �1WD recnmmrnds In+Ull�tlnn nf � Ihrrmd <br />np�neinn I�nk In pnrrm ��rraiivc prte�ure bnilA-up r�wrJ b) thr wuer hralrr. Applic:iµ �e`nowleAprf Mfnrm�tlon �s lo Ihr rarnmmend�linn <br />�nJ �smmrs 6�II rrepondbilih fnr ineuliinti nr f�IGnG �u inndl � Ihrrmel cRp�mimi �.xk. �_ IN7. <br />tiI�.P.\'I�'1 N71)RPSti ' � ' .' % ��" ._7�. ; � 1. <br />Clll'!tilAll'ILII' - �� �� . .. <br />UWNI�.R'tiNAMIi ����%�•� � r •�r <l � <br />I�ll'NI�R'1ADUHCSS�•'��i.:/'• .,nlr:"�•iy%� j' :,,-% __' <br />ru� sinnriir --- -- <br />I�hc picnuses uc In be uced ac a ��Y <br />��i �' �'�CL�1Y1'E_ <br />I �nrinper lns�alled __ V� <br />IL�vi.'IlnslnllrA <br />LO7'N(1 �� fli(KT.__ ______.. <br />_—�. �—, <br />PLAI'NAM!'. ' ' __ <br />I.GGAL DIiSCkIPTION. ���'� �'d' �• /? ��• . <br />IJ� y ,7 <br />RLUCi I'f:RMiT ISSUeD �Y ___ <br />INFOHMATION LfiTTF:R GI�'F.N: _ <br />f.t11�Q1::. <br />��� n . <br />(I I tiervice msulleWm d�. ronneclmn chugc S <br />H^"' ^ <br />1?iGcncnlfacihliesconnemmnchergc S_ "' � ` _ <br />// i r <� <br />F'AI D <br />AU6 - 5 09 <br />Ihtin,-ilnH;dlcJl�mmr I�itlthcr S, _ <br />I ntal emoum rtcervcd wilh eppliuuon S ��.: �� ��� M W W D <br />I I I', I'vl �Il:ti I i �� rl � I�mi thi� �pph.nuun �ilihouE�h �ignad +liall nnt he binJmg upon Iha MUF;IL7ii0 N'ATf:R DISTRIC'f unlil y�pimed hy ihe UIS"fltl(��I <br />1J <br />I tlir unAcmgned, awna I��i rrprcrenmirvc� nl Ihr pinMm Ac�cnheJ ehm�e. dn herchy meke epphtetiem fnr irttull��ion of e.___ �_ -inch Jiomelei ��nler supph <br />aniae cunnecu�m, mcludmF appurtrnuncts. onA ell necessep Inhn� at nn� etpenses <br />I lnled Ilus � Jn> ol . ^ Y <br />_._____' _. ? _". _—.—Li__ __ ..�__. <br />91'I'IJ/ ANl'ti' tiIGNMURI�. 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