Laserfiche WebLink
Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. G' ) Date: ) - / `ea r ,, ' , '.1 , ...- hereby makes application for water service at the following location: <br /> (owner) <br /> Address: "P A< V / (-!r- Lot: I Y <br /> Parcel No. Addition: <br /> Type of Building: t 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 /> Size of Connection: Size of Meter: r x <br /> Kind of Service: New, Replacement <br /> Improvement Type of Material: Copper(preferred) HDPE PVC <br /> General Service: <br /> No.of Fixture Units: No. of Floors: - - Water Cooling? Flow -"- gpm <br /> Other large water consuming appliances? Flow . qpm <br /> Fire Service: <br /> No. of Private Hydrants: Standby Storage: gal <br /> _ <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: . - ? , ,i <br /> Address: i` i n , _ + , <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 /> I� , 4 <br /> Signed: / f / __� .,t- -tt �' ,�_i." <br /> / , ( ,� .. Plumber <br /> APPIi ji,i tr/c-„ v.-.. .r - <br /> Address 1,�l. 7q f 7 (\/(�� � r r - .1 , <br /> Address <br /> F ,� I (- (----/ ! <br /> r / _ /slid �f� <br /> Phone Phone <br /> APPROVAL <br /> Date: 1 - I _r Water/Sewer Manager: , '\ \ - , r ,_, 1 <br /> White:Office Copy Yellow Town of Windsor copy Pink:Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />