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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. ' Date: i -S ~4 <br /> C9R. ,';, 1 t hereby makes application for water seance at the following location: <br /> (owner <br /> Address:5 Fti ?l $ E I Lot <br /> " <br /> p <br /> Parcel No -, <br /> Addition: r 6rti e e <br /> Type of Building: Single Family Multi-Unit Dwelling �mercial industrial <br /> Note; If other than single. -- y, please attach description and drawing indicbti ig type,and layout of service <br /> desired. See reverse side for rules pertaining to multi-unit dwelling/commercjalihdustrial buildings. <br /> Multi-unit structure option chosen: No. 1 Na.2 <br /> Size of Connection Size of Meter. . ;Y 3 <br /> " <br /> tend of Service. New" Replacement <br /> improvement Type ype of Material: Copper." ,efrred ,„ HDPE PVC <br /> General S ' <br /> No.ne of Fixture ervice:Units: " " ,»" No. of Floors`:"" Water Cooling? -~ Flow_gpm <br /> Other lar ge water consuming appliances?Flow "" gpm <br /> Fire Service: <br /> No. of Private"Hydrants: ° Standby Storage: .,w <br /> gal <br /> Fire Pump? Flow gpm Sprinkling System: .." flow gpm <br /> The customer is-respt nsible,for'the cost of Installation(lateral and curb«etop)Its'it is necessary to Install service from <br /> the watsr"mnain to the property line. <br /> Name of person or firm who will do the proposed work: <br /> Name: * .. !jm b " 3 <br /> Address: ,Ire f <br /> In consideration of the granting of this permit,the undersigned agrees: <br /> 1. To accept and abide b the rules arid regulations of Windsor Sanitary District#' as filed with the Wisconsin PSC• <br /> 2. To no o .-, :(- =r Manager of Windsor"Senitaiy District#1 when'thewater"system is ready for inspection and <br /> con a.: =lie"" -ter'system,but before any portion of the work°is covered <br /> Signed: F 1. ,1 1� 4 <br /> cant.` Plumber <br /> Address Addrss,` <br /> . 4r s'" <br /> Phone Phone <br /> APPROVAL <br /> Date: } / Water/Sewer Manager' "''''« ,�-A±-.... 16O ) <br /> White:Ofioe Copy Y.Now:Tovrn of VYkodwr "" Pink Cordrai*a/PfuiNier copy <br /> Please attach any additio ral condition*to this"application <br />