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Application for Water Service <br /> 1 Windsor Sanitary District#1 <br /> Application No. (7 t 2- Date: I " 2 / <br /> ''�r,,t () gel a-6,1 tionle-5 hereby makes application for water service at the following location: <br /> (owner) f 7 <br /> Address: v-./ C-i t e,4 ff '� t ,1Lot: <br /> Parcel No. Addition: t�t10/ -L J/Ucu <br /> Type of Building: Single Family Multi-Unit Dwelling - Commercial Industrial <br /> Note: If other than single family, please attach description and drawing indicating type and layout of service <br /> desired. See reverse side for rules pertaining to multi-unit dwelling/commercial/industrial buildings. <br /> Multi-unit structure option chosen: No. 1 No.2 <br /> t Size of Meter: S�� x 3/5' <br /> Size of Connection: <br /> Kind of Service: %: New Replacement <br /> Improvement Type of Material: Copper(prgf_erred) HDPE PVC <br /> General Service: _ _ <br /> No. of Fixture Units: No. of Floors: Water Cooling? Flow '` qpm <br /> Other large water consuming appliances?Flow qpm <br /> Fire Service: _ <br /> , <br /> No. of Private Hydrants: Standby Storage: gal <br /> Fire Pump? - Flow gpm Sprinkling System: flow gpm <br /> The customer is responsible for the cost of installation(lateral and curb-stop)if it is necessary to install service from <br /> the water main to the property line. <br /> Name of person or firm who will do the proposed work: <br /> Name: l_•r_a ,,t , \,f,/,es p v \j; 1 <br /> Address: I V o O. r -, Lj. 2- <br /> In consideration of the granting of this permit,the undersigned agrees: <br /> 1. To accept and abide by the rules and regulations of Windsor Sanitary District#1 as filed with the Wisconsin PSC. <br /> 2. To notify the Water/Sewer Manager of Windsor Sanitary District#1 when the water system is ready for inspection and <br /> `connection to the public water system,but before any portion of'the work is covered. <br /> Signed. A. .i,t' 'A t'/(17,_..- { .1 f 1-r�_t it—ii t--- . Cry <br /> a � � n <br /> ApAli nt ' Plumber , ` t <br /> Address Address <br /> (fi /,.�r1 r //QC (rte' - /- <- - `7O <br /> Phone Phone \ <br /> APPROVAL _ <br /> Date: ( 2-2 (S Water/Sewer Manager: A` -- j F.- ..---) <br /> i <br /> White:Office Copy Yellow.Town of Windsor copy <br /> \-..-rink Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />