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MUKILTGO N'ATGR DISTRICT
<br />APPLICATION �OR N'ATER
<br />��L�'). : % : � � J/ S. � � l •
<br />Metcr Sizc %�fJ Service Addrus: ?� � v f '
<br />Numbcr of Units: %
<br />� Yvicter will be used for (check ell thet apply): � Domestic _ Irrigntion _ Firc Servicc
<br />Acct. No.: � Q.�yS �
<br />fire Line
<br />1 hcrcM� upplc for weter servim end eFrcc tn ba govemed, in eccnrdanco with lhc rtsoluUnns, rula e�id rcguletions of lhe MUF:ILTEO W ATIiR
<br />bISTRICT (M'ND) perteining in w�eter service, nnw ur hereafler in etfect. Thc undersigned as owner or representetive of the hercin-describcd
<br />premiscs hcreM1}' egrets at fnlloas.
<br />( I � 'Ilu consumer epreca In msleil, apenm end memtein et ell umes, lheir plumhmg system m comphenee with Ihe eunenl ed�tion of 1he Unifn�m Plumhing
<br />Ce�1c u rt penems lo the prcvenunn of conmmmnuon, end pmtecunn Gom �hermel expensnn due to e doxA syslem Ihet enuld ocar wilh ihe Ortsem nr
<br />fuWrc mstelleunn nf M1nckllna pmvenlers na Ihe consumu's ttmec end�nr ei plum6mg 6xturts
<br />(21 The consumer e,^,ras lo mslell nll M1ukOnw prevenunn sssemhhes rcquesled hy Ihe MWD, end �o meintein Ihose beckllau prcvenUon usem6hu m gnnJ
<br />working ardec Thc nsxcmhllcs shell h� nf e typc, shc end mekc epprmed hy Ihc MND end thc Wdshmgmn State Depenmcnt of Ileel�h Authnri�} Thc
<br />naemhGes shdl M inslnlleA m rcmrdnnca e�ilh oll stenderdc estahLshed hq �he MWD.
<br />(l � The weter mtler wdl nal he mslalled unul e wnmr uxe survey he.� Men suhmined h) Ihe eppl�cenl end Um DuVieu Cmss Cnnneetian Comrol tipenehn 1'.a�
<br />� dclnmmcA illhe aslnmer wdl necd In msteh e hnckllnw preventer nn Ihe cuctomer's side nf Ihe meter.
<br />� A 1 Thet Ihe cust n( eny eMtrnsmn nf �he wxter senacc, rrnewaf, repinc<mem m repair �n «ach end !me Ihe pmperty descrilred shell M bmme Ay mysclf m
<br />nuignc u nwrer(s) nf ihc picm¢cv
<br />( 5 � Thel ell pipes, weler meacmmp devmes enJ other cannecunn eqwpmeN upslreem finm Ihe meler shell, efler Iheit msullnuon, he end becmmc lhe prn�rry nl
<br />Ihe MN'U, suh�ecl lo ell its rcFuleunm penemmp In wnler service
<br />(G7 Tlmt e(Icr ms�elleunn, il mcicr nr mcter hnx enJ eppunenenccs m< Auncd a detnepcd, lhc nwner, will bc hclA respnnsiM1lc end chwgcd for semc
<br />(7� 'fhnl Ihc Mk'D, ils oll�¢crs end egcnls, ehnll hevc Ihc nRM of mgress enA cgrtss to go upon Ihe prcmises end prnpcny dcscnlxd hcrem for Ihc purposc nl
<br />mspecGnn, cnnncumg m A¢connectmg Ihe servitt m(nr such nther purposes as Ihe scrv�tt mny requi¢. II ts nl5o undersl«�d dunng Ihe Ume Ihnt nn)' af
<br />Ihc we�er mems mny hc au1 nf urvme hy rcavnn nlenr emcrFrnn� or impmvements eulhnnmd hy �hc M WD. in eny strtct m aUmr Incetmn m wh¢h Ihq
<br />mm heve bcen Inid,lhe MWf> wlll nai Fc reqwred in (umish wn�er dunng �ha pm�ess of xuch impmvemen�s ta en� cnnsumer whnse suppy� ma� �hus hc
<br />nn nQ on c� hnblc fm nm� dnmeFa Inr rtv faiWrc 1n dn sn
<br />, µI mete ftl t 1 cFicter Ilho ualer�cu�sumedh�The A1 WU�shnll nut Ae held�eble fnr dameFc h}rwaier�or nlha ceuse resulung fr m�defretivcnplu�m6mgl"Ihc
<br />xn Iln �Imnces sfhell notll c pleeJ a� e h�nsn�for mcovmc m cacet� f dnn� ge nNefnrcen I` If Ilho eupply afLwelerh hu I Iil nr hehimerrupted by rcnsrnuof I�F
<br />i�cnAam, low pressu¢ nr nlhei cautt xhxlsixver, lhe Iv1WU shnll nni bc hcld hehle for demegcc mr shell such (eilure nr mtenupnon for eny reesnneMc ume
<br />he Leld tr� cnnstilWe n bmnch of cummoi nn Om pM of lhc A7N'D ar m eny wey relicre Ihe consumn, whe�h[r tennnl or nwner, 6nm pednrming lhe
<br />nbhFelinn nl wch Icnnnl's nr mrna's rnnuncl Weter shnll hc uud M applicent only nn lhc prtmiscs descrihed hercm A new epp6cnuon shell hc Gkd
<br />�hnuld wnlen c� Jesirtd Irn nlher peinise+nl�hnuFh IncxleJ an InnA JescnheJ hercin
<br />�v� "Ilin Ihr NN'U rrrnmmrnds Ineullalian nf � prn�nre rrCuln•:nC vdve. Applianl �c4nowledRes fnfarm�tinn u tn the recnmmenJ�tiun �nd
<br />�emmrs full�r�tpnndldlltp fnr invxllmF nr failin� tu Inelr" � preieurr rrFnl�linC rdn an IM1r wnrr eyelem In prolrrt 1� tram hlRh
<br />�rrt�surr. �.__ 11I.
<br />�1111 l�hr MN'U ulilivn rheck vdvri el ILe memr m prrv� ,t Ma1rr rrlurning lu Ihr Uislrlcb mdm. 7'he M\1'1� recommenJs fnsUll�tinn of � thcrmd
<br />�qnminn unk �n prrvrn� exaeirr prenurr hull•'+qi awcJ hr Ihr w�ier hn�rr. Applla1�11[,tenowleJ��e Infmmotinn u tu Ihc rrrnmmrndulion
<br />and n+umn full rrspnmi6Hfh far ImldlinF nr fdlinC �n Ineull � Ihermd esp�nefon unk �_ 11T.
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<br />� I I 1"tiTAl17l.IP �'��� _—_ ._.., BI.UQ PIiRMI'f ISSl1F:D IIY. _ --
<br />i n: prcmisa erc m hc uscd e� e�` `/� _ MFURAIAT�ON LFi1T1iR (iIVC:N� —.-- -.
<br />i l �'IS:LTY11:. Silel{�L}- 4;�>� -,
<br />i�r� duper Inrmlled _� _ (I I tiervice mslel�euon R mnnecuun cherge S_ `/�^ -.
<br />Uulnn InstalleJ _ (A �ienerel Fecililms ennnecpon chotge S -
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<br />(3�(Mh<r s - ..
<br />pkn¢I InsiellcJ fulurc ,._ � �'
<br />Tmel mm�un� received wrth epphceunn f__' �� '-.'.
<br />I7� Iti l INP[Rti9�(N�P �hnl Ihis Apphcnlinn. elthough signcJ, shell nnl M1c bindmg u�wn Ihr MUF:IL7'I:O �1�ATF.R DI51'RICf until eppmvcd b� Ihc UIti fltic-�I
<br />'� � NC�1 A�nm�lh mPlff 41ID111\
<br />�, Ihc unJersipneJ, nxner I��r rcpres<mnuvci nf Ihc propenc descriFed elwvo, dn hertM� meke yfphwnan (oi mslelleuon of a__'
<br />sen�ice cnnnequop, inch�dmg nppuMn+mce�. nnJ oIl nttesse�t aabmAl m) expenses
<br />! qurd Ihn `-' � Jm nf _ ._ ' - _—_
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<br />'�prull)nar _____ .. Svcnflkvlce CCSlniuels_�'�y(�
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<br />PAID
<br />sEr 7 u
<br />MWWD
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