COM 0327.003 2002-2004 - Laserfiche WebLink

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-Mav 29 03 02:16p p.2 APPLICATION FOR WATER SERVICE The undersigned applicant requests to be supplied with wafer service by Hookena Water Association for the purpose shown in this application, and for no other purpose. Applicant agrees to pay for such service within 30 days after receipt of billing for metered service, and agrees to comply with Association's rules and regulations. Such rules and regulations aze by this reference made a part ofthis agreement. Applicant agrees to claim no damage on account of the stoppage of the flow of water resulting from accident, or when stoppage is necessary to make alterations, repays or improvements. Applicant shall keep all plumbing fixtwes on applicant's premises in good repau and shall promptly stop all leaks from such plumbing fixtures. Applicant agrees to pay the water service cost to Hookena Water Association until such time as applicant orders the water cut off or gives notice to Hookena Water Association of applicant's removal from the premises. For failure to comply with this agreement or any part of it, applicant acknowledges that Hookena Water Association may terminate the water service to the premises described in application without notice to applicant, however, Hookena Water Association will make attempt to notify applicant of such action in a timely fashion. Name ofApplicant for Account: Mailing Address: Phone: Name of ovmer of premises: Mailing Address: Phone: TMK# ofpremises: Deposit in full: YES /NO If No amount owed Meter number; Size and type of pipe to meter: Intended use ofwater: Household J or Other If other specify details Shutoffvalve installed at meter: YES / NO The number and kind of fixtures through which water will be supplied: I have read and agree to the Schedule of Rates, which I understand will be assessed, adjusted accordingly and reapplied on the first month of each yeaz. Dated: Signed: ~ ~Ino~ 1i ~;0~ Na 327.3 Ref. TaPreas' e7 q bj b l X30 Ref. Dote ~ i ~,1 i G_ ~ , C