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Sewer Connection Application <br /> ``^^ Windsor Sanitary District#1 <br /> Application No. CPO. ( o. Date: 1 " 2-I - 2-C E' <br /> 7tt t () 13 r I k. 1-I b{tip > hereby makes application for sewer service at the following location: <br /> (Owner) <br /> Address: aSIL/ 6)e►'} Lot: .2 7 a Block: -- <br /> Parcel No. ''/ Addition: I.�Jb.i )S`a iio <br /> Type of Building: X Single Family Multi-unit dwelling Commercial Industrial <br /> Kind of Service: New Replacement Improvement <br /> �� 1 <br /> Size of Connection: L/ Type of Material T- C.- <br /> Name and address of firm doing the proposed work: L)r<..= ,,..\'‘,`,(2 f _, ,` "_-=� <br /> The customer is responsible for the cost of material and installation from the sewer main to the structure. If a road <br /> crossing is necessary,trenches in paved streets shall be refilled with compacted sand or gravel.There will be 6" <br /> deep concrete bridging placed over the excavation and 2"bituminous mixture(hot mix)placed over the concrete <br /> to match street grade. <br /> Remarks: <br /> In consideration of the granting of this permit the undersigned agrees: <br /> 1. To accept and abide by all provisions of the sewer use ordinances of the Madison Metropolitan <br /> Sewerage District and the Windsor Sanitary District#1 and all other pertinent ordinances or <br /> regulation that may be adopted in the future. <br /> 2. To maintain the building sewer at no expense to Windsor Sanitary District#1 <br /> 3. To notify the Town of Windsor Plumbing Inspector when the building sewer is completed and <br /> ready for inspection, but before any portion of the work is covered. <br /> 4. To install tracer wire and grounding rod in accordance with WSD# 1 ordinance. <br /> Remarks: <br /> - 2 Z - /s Signed f �/ f �i{ t ' if '`� W �---� <br /> Date: 9 <br /> (apPlli t) f/;� J <br /> $ (a d -� Hookup fees paid. �o 11-� i `�i. I1 t 1 ( %c r <br /> cp <br /> (address of applicant)) /1 f;7 .-' i. n ._ J /t z -_ :, ',/ <br /> -, CU2_.<< (ir`r('-' <br /> ' /-�;. / - //t10 <br /> ($uperintendent, clerk, etc.) (phone) <br /> CONDITIONS: <br />