|
��
<br />Application No. _------ ---- --
<br />. �,,.., _ . .
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />/
<br />�
<br />..
<br />i
<br />No. --- -------
<br />Account No. � ��+���� (' ��
<br />'��!� Number ol Units -----
<br />Meler Size — ------ —
<br />I hereby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulations of ihe
<br />MUKILTEO WATER DISTRICT peAaining to water service, now or hereafter in ellect. The undersignea as owner or
<br />representative oi Ihe herein described premises h0reby agrees as lollows: � 6neii be bome
<br />(1) Thnt tho cost ol flny oslonsion ol tho walar sorvice, mnowel, ropiacemont or repelr to �eech end eorve �he properry describ
<br />hy mysoll a xssigns ns ownar (s) ol tho promisos. n, be end become
<br />(2) That ell pipQ o11ho MUKILTrEO WATER DISTA CT�tubjocl Well iPe ropuletions po'rte nleq to weter eervlcel �h��� Instellet o
<br />tho proporry
<br />j4jThn1lhnMUKILTEOWATERrDIrSTRIGT�itsoll�'�co6endepon�s,shollho thonghlolnqeesendoposntoguu�ponlhopmn�sesandpropeny
<br />desaibod horain for thn pwpose ol inapoction, con�cting or t�sco�nectlng IM sartice or for wch othar purposoe es lho eo m�o mey require.
<br />byslhoSCISTRICT�m nnry sVoo'or othnr lacnlion n which they mey heve bo'e Iwld, �ho DIS RICT w II olr6e mqu red o tu�;� bn Wa�amd� Z�o
<br />tho progross ol such ImF•ovamenls to eny connumar whow euppiy may Mu� he cut oN, or be liebin lor eny dmm�ge� lor Itg leiluro Ic do so.
<br />(5) IohlostnllDosmolm(s) Ioro�1s�orthowntorcansumodrTheDISTRIGTthel�lnotbo�holdlablelordeme'gobywe�ohoro orca3usarosme^9,'e�
<br />Anloctivo plum6ing or npplinncos fnstnllod by Ihe ownor or ocapnnt on Mo p�omisee euppliod with wetot, ond Ihe lect thel apen �s of Iho DISTRICT
<br />mny hevo inspactod Iho plumbing end eppliancos shall not be plexd ee a 6asis lor mcovory in cese ol dnmepo ae eloresai d II Iho supply ol
<br />nor ehell 6u'ch faiboa a9 i�A«�� ion lor eny roesoobla Wmo be Aold to coenettuln e breach ofrconlreclSai �he P�rt'°� me DIS TqICT orindany wey
<br />raliova �e cansumor, whothm lonnnl oi ownar, Irom pedorming the oblipetim al tach lenentY or owner's contrect. Watar ehell be ueod Ey
<br />epplicent only on Mie promisus dnscribaA haroin A new epplicelion shell bo lilnd ehould wetor be dexi�od lor other promisot ellhough IocateC
<br />- , on land dasaihod heroip Ilunt ecknowledBe� In1orT�llon �� to the
<br />irir .__�—__18) Thet the DISTRICT recommends Ins�allallan of � P�enur+ reguleting Valve. APP 0 ew��er�y�lsmu
<br />recommende�lon end essumee lull re�ponelbllliy �or In�IaIIInO or �dlinp to Inslall � prc��ur� regul�lln vdu� on 1h
<br />_ proleci li Irom high Preseuro. Ilce
<br />itir'�__ -._1�) i�'��es� ��o���hlairmels�p ndonlenklohp�evenlevcasdwprse�unbulld!upc�a��dbylhew�arlhsel �hAppgT h�eoknowledgn
<br />� Inlorm��lon �� lo Ihe r6kommendellon end �aume� lull ro�pandbllty lor Iq�idllnp or blllop lo In�ldl BLO:K •f aNp�ndon t�nk.
<br />:..'
<br />i� ' ; . � . . . . � ', LOT NO. .
<br />SEFlVICE ADDRESS�. . _.. ---..---' . . . -- �'. . � ! � �'. � i.. �- ,�,,, �l ..
<br />� � PLAT NAME�. ,
<br />. . - ����.e. � . �.,, ..� '- �.
<br />- -" ��— , �,':"1,�'�f' < <-- ' '� ` LEOALDESCRIPTION: ,
<br />GTY/STA�EIZIP�. � Il"v: ,:�'t'�
<br />� OWNER'$NAME'. �.���' I:��,.,.i �,��t � �.?n- �. _ _ , , ,. � .
<br />, ��` ^��'•`� ( — — — I
<br />OWNFR'S ADDRESS� �•_ , -i � �
<br />i �.,..liS�.
<br />GITY/STATEIZIP �' � �� , �. � � '
<br />_ � .
<br />iho premisas ere lo bo usod as e �. ��, . - .__ _
<br />-,�f- INFORMATION IETTER�GAVEISENT:
<br />��-- CHAROEB-. 1�(� I I 1
<br />/ i� �i ) ., ",1'.
<br />(1) Service fns�ellelion 6 connnction chorpe S----�-----
<br />�:'�7).,:�(! (Ilj� ��
<br />(2) Generei Fecililias conoection cherpe S-- . �,.
<br />(3) Othor f -- 1 � . . � i ,
<br />,�",'_!� i'�. . . �... .
<br />I unl received witl� epplicetlon S
<br />ioie emo
<br />I f IS uNDERSTOOD tlin� this Appliu�lion, ehhough 6lgned. ehell not be binding upon 1he MUKILTEO WATER DISTRICT unnl epprovad by tha D19TRIC
<br />I, ihn undornignnd, ownm (or represontative) ol the properry deatdbad ebove, do hereby meke epplicelion kr inttalledon ol e__ �� _— -Ia
<br />duimulm weter typply som�n connoctioq,�ncluQing opDurtenence�, end ell n�eapry�lebor el my eKpentee
<br />J
<br />Dated ihin � � _ doy_ol __ � -- .
<br />� ' _ � �. . � '_�- � ' r, - --- "
<br />APPLICANT'S SIGNATURE� --,
<br />a . S � �.
<br />ApplicnnYs Name (Ploase pnntl: --�. , tt �� �� 1 �.i � �1.� _� `, �k�. �.' � �', a!_� � � � �� ' '
<br />Applicanl's Address and Phone Numbec � ' � _—
<br />APPHOVED: — --" —. — —
<br />MUKILTEO WATER DISTRICT
<br />ey
<br />%� �
<br />Dale. __ :3,,7. :: ��-
<br />
|