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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 7 o u C. Date: - -i <br /> 1\ ,' hereby makes application for water service at the following location: <br /> (owner) <br /> Address: ` t-:,() i \I, :w_. l A Lot: o <br /> Parcel No. -" Addition: r (ck <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 /> Size of Connection: . ( Size of Meter: > x j- <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 qpm <br /> Other large water consuming appliances? Flow " qpm <br /> Fire Service: <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 /> k <br /> Name: <br /> Address: r'�c�, r v-1 <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: - q ; <br /> Applicant Plumber <br /> r t <br /> ' I <br /> Address- Address <br /> Phone Phone <br /> APPROVAL <br /> Date: - � r ti Water/Sewer Manager , � :. r I <br /> White:Office Copy Yellow.Town of Windsor copy Pink:ContradodPlumber copy <br /> Please attach any additional conditions to this application <br />