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MUKILTF.O N'ATfR DISTRICT <br />APPLICqTION FOR N'ATER <br />'vtcter Sizc: J/� Service Address: ��'yy �` �=% ��� - � r� <br />Numbcr of Units: � <br />�Wleter will be used tor (check ell thet apply): ✓ Dnmestic <br />Acct. No.: �_p^i� � <br />Irrigation Firc Service __ Firc Line <br />i hereby apply fnr aater servico end egrce ta bt govarned, in eccardnnee with the rcsolulions, rules end regulelians o(the MUKILTEO WAll;lt <br />DIS'fRICT (MN'D) pertaining �o wnter servicc, now or fic:c�fter m elYecL The uvJersi�ned as owner or repraanwtive o(the herein-describcd <br />premises hereb�� egrees es fnllows: � <br />( I) 7he consumer egrees tn msull, operete end mo.ntem nl ell umes, lhar plumLing system in complienec with Ihe curtent edmon of Ih< Undann Plumbmg <br />Cede es it penems In Ihe prcvemmn nf mnmminehim, end prrnecunn Gnm �hormol expnnsian due In e clostd syskm Ihet could necur wtlh Ihe prcseM oi <br />fuWre mslnllnuon nf heck0ow pmenters nn Ihe cansumer's service enJ/nr e� piumhmg fixlures. <br />f:l The cnnsumer eFrtex lo mslall eIl heckOnw prtvenunn sssembhes reyucsted b}� �he MWU, end lo memtem �hox h�ekflow prcvrntion n�sem6ha m FnoJ <br />wnrkmg nrder 7'hc rtssembhes shell be n( e Ivpe, sve end meke eppraved by Ihe M WD end �he Wsshm�ton Siete Depenmrn� of Heelth Amhornr "fhc <br />nssemAhes shell be mslalleA m eanrdnnce wnh ell stenderds estahLshed by I`- MWU <br />(�1 Tha weler meler will nol Fc roslalleA unlil e wxler use aurvey hss been submined hp the �ppllcenl end Ibe DatneLs Cross Connecunn Contml Specuhs� hes <br />delermined if Ihe cuslnmer wlll neeJ lo mslnll e heckOnw prevemer on Ihe aslnmer's side nf Ne meter. <br />141 lhet �he mst n�eny eK�ensmn nf Ihr w�eter scrv¢q renewel, ¢placemem or repert In rtech end serve Ihe prn�xmh) descriAed shell he bome M1y mysdf m <br />rtsvgns na nx�ncqs) nt Ihc prcmiscs <br />f 5) 7he1 ell pipes, wekr mcawnnF device� end olher connecunn eqwpmenl upstream Gnm Ihe memi shell, efkr thcu mslelleunn, he mA becnme Ihe pmpen� nl <br />Ihe MV.'U, sub�ecl la ell as re�;ulMmns peneming In weler semce <br />1l�1 1he1 eflu mslallel�an, if mclei nr mcler box end eppunrnences ero huned w demeged, Ihe nwnrr, wJl hc held ms�msiM1le anJ chuged (nr semc <br />('1 lhet the MN'll, ils nlllcen nnd egentc, shell hnve Ihe ngM of inFrcss end egress la �n u�n Ihe premtses end propeny described he¢m for the purpose nf <br />mapecunn, cnnnecung or dixconnecling Ihe scrvicc nr fnr such niher purpnses ns Ihe serv¢e mny reqm¢ li rs aha undersUnd dunng the �ime �het eny ol <br />Ihe wqler mnms mnr he nW a(scrv¢e h7 rtdsnn nf eny emergrncy nr imprmrmrnLc euthnn>ed h) Ihe M WU, In eny sUeel nr olher Inennnn in e�h¢h Ihe� <br />mxr heve heen ImA, Ihc MN'17 xill not Fc reym¢d In (umrsb weler Junng Ihc pmgrcas o(euch imprmemcnts tu nny rnnsumtt whnce supply mey lhus hc <br />eW �iIT, nr bc hehle fnr any Aamnges fnr iLv lnilum In do ui <br />�N 1 ihet Ihr M W U shnll hove Ihe nght In chongr �hc re�es e� em� umc hy Itesnluunn, In IempnrenlP d¢conunuc Ihe urv¢c In consumers, nnd lo mstell Ihc <br />mcmqs) In rtFisle� tlu xeter cnnsumcd lhc MN'U sheil nm bc hcld hohlc fnr demege hy xe�er nr niher uusc raulung from defcctive plunihmg m <br />apphences mslelled hp Ihe nwnei m ncnipenl on Ihe premises supphe� wtlh wekr, end Ihe fan thnl egeNs n(the M WU mey have mspecled Ihe plumhm� <br />anA epphenws shell nm be plend ac e bnas fi�r mcovep� m cuvr of dnmeEc as n(omsniA If Ihe supply of weter shell feil or be iNenupled by reunr nf <br />xcuJcni, Inw prrssurt ar nthcr ce��sc whetsocvcr :hc MN'D shnll nut Fc hcld Gnhlc fnr demagc� nnr ehnll such feilurc m imcrtuppnn for eny rencanxMc tiniv <br />Ire hclA lu cimxlnute n hrench nf cnmrncl nn Ihe pnn of Ihe MWD m m eny wey reheva Iha coneumei, ahelher Ienenl nr nwne�, fmm perfortnmg fhc <br />uhh�tnlion uf such Ienanl's m owner'f canlrecl N'nitr shell tre used hp epphcem nnly nn Ihc premises descriheJ heiun A new epplicatian shell he GIcA <br />�IinulA amcr hr JavcA for olhcr prrmiees ehhnu�h �ncalcJ �m IanJ Acscrihcd hncin <br />1'4 lh�� Ih� MN'Il,rr mmends imull�llan nf � prea�urr re�nlalinC v�lvr. Applinnl �cknowlrJRr. in(arm�linn �e In Ihr rermmmrnJuion �nA <br />n�rnmr� full rr� nalhlllry fnr Insldlin� nr fdlin�; lu fnelull o prr.surr rc�ul�tin� sdvr an Ihr w�la eretem In pralrrt If hnm hig6 <br />prrx�urr. INI . <br />IIIq l�hr �1\1'I� uNltrrs chrrk valvrs �t Ihr mrlor In prrvrnl wurr raurninp In Ihc UletrlcB m�fm. Thr MN'U recnmmenJs imidl�linn ol o Ihrrmxl <br />rtpnn�inn unk lu prrrrnl rsreuivt prneurr hnih6up nuuA hy Ihc M�t�r hrelrr. Applie�nl �pkl%wicdRei Infnrm�linn u In Iho re�nmmenJ�unu <br />■nU �aumrs full rrepnnaihilily fnr imldlinC nr GIIinF to InnUll u thrrmd r�n�mlan I�nk. __ INl'. <br />tilltV'ICI�AI)Ulilititi '��U. '!�^��':!• ''. �� �• LOfNtl � � BI(M'k <br />�_ . , . ' _ . . _ __— __ . _ — . <br />1 ..�4 .�•; . -r <br />i I Il /tiTATII/II " V %.. " I I AT NAMII -' ! _���' <br />- , -. -- �.�- T7_ 7 _ <br />n1PN192'tiNAMI � `" ����y `-'''�`� 11(iN.DGtiCRllflO . <br />�i141.1(R'SAbDR1.VS.�: ,J�Y �� l�, 'yi�ry� �73'1�_ . /����VG �J �% ' � �'. /_'.1 � .. 'd:/ <br />�'II1'/STA'11:21P_�^�— •�— __ f3LIHiPI[IiMI'IIStiUBDflY . _ _. <br />I lir pramises erc ia be useJ aa e "�" __________ INPORMATION LI[TTIiR CIVF.N- _. <br />sru��ti:L7YPL i!LAIiSiLS. p�� : � . <br />I �e� elnper Intlnlled � 11) Sm¢e mstelleunn A ennnaunn chupe S_ �� <br />I han<I Inclelled ____ �21 Gene�nl Fecilnmx c�mne�tmn chetpe S_ ��l ... <br />I n�inci In��aIlcJ I�ulurc Q� (Aher 5 <br />_.__—... �� <br />"Inud ammim rcccivcJ wnh npphca�inn S "� J' __ _. <br />I I IS l iNUGRtiTOOD lhe� Ihis Applmaliaa, nl�hnuFh signed, shall nm hc hin�Lng upon ;hc MUI;II:I"h.( � N'ATI'R DI517<ICT until epprnv<J M thc UIti1111�� �� <br />. 't <br />I ihr undarsipned. nwner Im reprcsemairvel nf �he pny�eny Jescnhal ehova. Cn h��aM nudv npphcmnm tm mmJluiwn nl n �inch Ammaet anler s1u1� h <br />.��niu� mnnectlnr.. mcludmF appurlenanees;end all necersap 4iLoee� m� expenxn -. -... ArK - l W <br />I t�md tlus � Jm nl � _. <br />,���,� �� .�,,����,N�,�,k� - - -- MWVv, <br />�npLcnnl'� Neme �please nnntl _ <br />npplrceni's Add¢sv S Phonc Fumhe __ <br />('RcltiSt'n4Vill'I7�INCUN7ROLSfIA1MAR1'ASSI:SSMfMBACAFLON'RP.QUIRPD'_r�jT�- x NOs/p�,4 <br />I� pr nl I1r� u�r Sve of I hv¢e i CS Innmis�T Uele _��� <br />_� <br />AI'1'It0\'F'f�r 111UA11.7'F.ONATF:HDI57'HI('{- <br />Ih /j /// - / ��- <br />� �1vv I�air���7�/�r.. I5911[JH\ �_ <br />� _ — <br />