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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5401 <br /> Date: 2/11/2015 <br /> Veridian Homes AB,LLC hereby makes application for water service at the following location: <br /> (owner) Lot: 237 <br /> Address: Dutch Diamond Way <br /> Parcel No. – Addition: Holland Fields <br /> Type of Building: X Single Family Multi-Unit Dwelling Commercial <br /> 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: 1 inch Size of Meter: 5/8 x 3/4 <br /> Kind of Service: X New Replacement <br /> Improvement Type of Material: X Copper(preferred) HDPE PVC <br /> General Service: Water Cooling? -- Flow __gpm <br /> No.of Fixture Units:-- No.of Floors: -- <br /> ether large water consuming appliances?Flow-- gpm <br /> Fire Service: Qal <br /> No.of Private Hydrants: -- Standby Storage: <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: Dave Jones Plumbing <br /> Address: Madison,WI <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 t•the public,water w"(�atee�r,,,system,but before any portion of the work Is covered. <br /> j `/ <br /> H071 es , c, ` Dave Jones Plumbing <br /> Signed: V •r : s•– _ /I C h„ Plumber <br /> APPIi nt � <br /> (Q 51 0( Sow ` )<1Q,Qie.-4 Madison WI <br /> Address Address <br /> (t2D --a- Co - 3 v (°S fay 8`1a� <br /> Phone Phone <br /> APPROVAL <br /> Date: 2/11/2015 Water/Sewer Manager: �— <br /> E Yellow:Town of windsa copy Fink Contactor/Plumber copy <br /> wnne:Office cow application <br /> Please attach any additional conditions to this appl <br />