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� MUKILTEO N'ATER DISTRICT
<br />APPLICATION FOR WATGR
<br />�i�� ar�, i` ,� ��. s �.
<br />Metcr Sizc: _ Service Address: --
<br />Numbcr of Units:
<br />`Meter will be used (or (check ell that epply): _ V Domestic _ Irri6etion _ Pirc Service
<br />Acct. No.: �Q�' � O
<br />fire Line
<br />I hcrchy eppl�� for water scrvice and egrec to Ac gavemed, in eccnrdence wilh the rtsolutians, rukx and regulmions of lha MUKILTFO U'ATf.N
<br />DISTRICT (M WD) peneining to wmcr urvicc, nou nr hereafler in cffea, The undersigneJ es nwner or represcmative of ihe harein-descrihed
<br />premises hereb}� egrzes es fallows.
<br />( I) The cnnaumer �grces In �rtamll, npenle end memum et ell lim<s, Ihev plumbmF sti��em m comphenee with the cunent ed�uan of Iha Uniform Plemhmg
<br />Cl1de l5 11 �Itrt�In51n I�IC j�rtv[p110n O�c011IM1100�100, end �ItOlCtlbn �fnlfll�1emlBl t%�IenstOn dll[ 10! CIMtd Syslem UI�� Wllld O[tpf WII�11�1� jlttSCnl �r
<br />Pomre ms�ellelron nf beckOnw pmvrnlers nn Ihe cansumer'f service end�nr et plumbmg fixturcs
<br />(21 wnrk�ngs rde� �l he aascm6Gcs shetl 6c af e tpx sin end mekc eppmvcdeh �hc�MWU[and �ha We.ahin�ton Swe fJepertment,af Hcelth Au h n5nn Ilic�
<br />dsumbhes shell be in�lnlled in ncmrdenec wilh ell stenderds exiehhthed hy Ihe MWD
<br />(7 � Thr weter meler will nnt be insiellyd umil e water use surve) hd� be�n suhmmeJ hy Ihe eppl¢enl md Ihe Disincls Cmss Connaunn Cnntrol Specinlist hns
<br />delennincA if tha custnmer wlll nad la mslnil n FeckOow prevenler nn tl¢ cuslnmer's siAc nf �he mcler
<br />f41 Thm Ihc rnv nf eny ealensinn nf Ihc wnler urvmc, renewel, replecemeN m rcpert 1n reech end sme �he pmpeny do.cribed fhdl M Iwme M1)' myself n:
<br />ncsiRns ns nwneY,si ��f Ihe prcmises
<br />� s � Thnl ell pipes, weler mcuunng device. xnA olha cnnnecunn eqwpmem uptireem fmm Ihe mcln shnll, efler lheir ms�dleunn, be md hec�me Ihe prupcin ol
<br />Ihc MN'U, suh�cct tn �II iLs rc@uleunns pcnnimn4lo wnlcr scrvicc
<br />p� � 7hei �Iler m�lelleunn, il meler m meter box end eppimenences erc huned or damaµcd, lhe nxrer, uill M1c held respnnsihlt anA cherged for semc
<br />1? I Thnt Ihe M WD, ils nlfittrs enJ egrnls, shell heve the nghl nf mg¢ss end egrtss �o Rn upon Ihc prcmises end pr�erty dacrihed hercin for �he purp"se nf
<br />mspeainn, connec�mg nr daconneclmg Ihe scrv¢c nr fm auch othei purpoxes ss Iho scrvice me} rcqnrte II is :Jso underslnod dunng the ume �het am nf
<br />Ihc weler mmns mm� bc nn1 nf ecrv¢c Fr reaann of eny cmerRrncy nr nnpmvemrnls eulhorvcd M1p lhc M WU, in enq �Itee� or nther Inution in ehich Ihe�
<br />me� hovc heen Imd, Ihe M WU will nnl Me n�uued In Pomish welu AnnuF lhe pmFrcss ol such impruvemems tn ony consumer wh�xe supply me� thus hc
<br />cw oR, or Ix hnhlc for any danwFrs fu� rts feilum :;� do xo
<br />'A' n clerfsl 1�i cgislerltlhe wetei�cansumed1pT1 c MN'D slmtll nal he held'ItinMc fnr Amm�g'c bYrWrnlerdm nlhvi ceu¢ ie.cWung ftamSJe(c IivcnplumbmF nnc�
<br />�frpliences malelled hr lhe mmer m necupnN nn Ihe prcmisex eupphes wllh weter. end Ihe !ea lhet egrnts of Ihe MH'D may heva inspacled Ihe piumhmg
<br />nnd npphences shell nnl Fe pleeJ nc o hnsu �irr rccovep� m esac of denrege ns nlarcseiJ If lhe supply af wemr shell feil m he imerrupud hy reamn nf
<br />nccidrn�, Inw pressurt o� other ceuse wlmLsnever, lhe MWD shxll nat Iro FdA IieFlc far demeges nm shJl such (eJure nr mterrupunn for eny re2vonnMc timc
<br />bc helA la conslnWe e hmech af commcl nn �he pnrt of Ihe MN'U m m enr wey� reGeve Ihe consumer, whelher Icnont nr oxner, fmm perfntmm� Ihc
<br />��6hF sunn uf such tenem'n m owner's comract W emr shell be used h}� npphcem only on Ihe p¢misca dese�ibed herem A nca npphceunn shell hc liled
<br />rh�mld wnmr he Acsirtd fnr i+llmr premiso nllhnugh InenteA on IenA dacrihed herem
<br />''11 • cumetr full,r�qf�n� hlliln'fm ina1�I11ioC arrfdlin� Inrfnel�'I a•pre mrc`rr�ul�lin�n�dvr on Ilhr wf�krreyflem to prntech 1� hnm hi�h �Ilnn �nd
<br />. prr�eurc ` � IM�.
<br />1101 l�hr �1N'U ulltvn dircA vdrre �t Ihr mel•r In prrvrnl w�lrr rrlurninF Ia Ihe Ili+lricis m�ina. l�ha MN'p rrenmmenda Imtall�linn nf � Iherm�l
<br />��pxmian unk 1n prrvrnl r��reenr pr�esurr bnilA�up cau�rd h� thc w�lrr healrr. ApplirfiNt4nnwlydRrs Infnrm�tlnn �s In Ihe recnmmend�llun
<br />�nd u�amee Inll rnpomihillly fm inadlinF ur faiiin� tu ineldl � Ihrrmd rap�nnlnn unk.�_ _ t1'I-.
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<br />n15'NIiR'ti AUUItP.titi.. __ ___. . -____------
<br />"'�;��•y HLIXiPGItMITISSUEDDY -----------..
<br />lll5��til-AI'PlLIP '_____ . ��--- '—' _.._ . _
<br />�' r' WFOHMn'(ION LCTTEk (iNEN.
<br />Ihcprcmucsmclohcusedn�e________ _. --
<br />sruv�se n�r1 ✓
<br />I kvdnpc� Ins�nllcd . ____ _.
<br />Ih.incllnelulkA _ _ ._._ .
<br />I n.mci InslellcJ PuWrc _. _ _
<br />4l1Afi41:5.
<br />( I 1 tiervice inxlallalion 6 conaecunn cherpc
<br />(2) (ienenl fecililies cnnnecuon chergr
<br />(71(hhcr
<br />l� tel nmaum recaveJ xnh epphceUan
<br />I I IS UNI�fiNSiex)D Ihe� this Apphceunn. ehhnu�li signed, shnll noi bc hmJmg upim tlm MI II;ILTF.O WATF.R DIS7RICT un��l epprm'ed �q t�'� UlSlltk �1
<br />I ihr undeniFned nwner I�r rcprrumeuvri nf Ihc pr�eny deurihcd nhnve, dn herchy mnke epp�meurm fnr ins�ellelwn nf e.__ ___
<br />-inch Jien¢tu wntcr supph
<br />,cn�ice mnna�iun. mclnJmF eppunmuicex, ond ell necessapl�y��l my upenxa
<br />I CurA Ihn J dm� ul '� . _�1.�,.•� ---
<br />__ - -�._� , PAID
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<br />\ppLcnnl's Addrtss A Phnnc Numher __ __ __ --._— --- --
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<br />Svc of IRvice CCS Iniusls ��_� IMu� _��
<br />Irpi�n(Ilcv¢r .. .____ .. ._... -- �
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<br />IssueAfl�� ___ ._~.
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