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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5366 <br /> Date: 2/11/2015 <br /> Veridian Homes AB,LLC hereby makes application for water service at the following location: <br /> (owner) Lot: 265 <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 /> Site of Connection: 1 inch Size of Meter: 5/8 x 3/4 <br /> Kind of Service: x New Replacement <br /> Improvement Type of Material: K Copper(preferred) HDPE PVC <br /> General Service: Flow <br /> Nd.of Fixture Units: -- No.of Floors: -- Water Cooling? — <br /> Other large water consuming appliances?Flow— 4pm <br /> Fire Service: <br /> NO.of Private Hydrants: — Standby Storage: — cal <br /> Fite 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 /> conie�tton o t public water ystemsut before any portion of the work is covered. <br /> v 2 t f . L.L Dave Jones Plumbino <br /> Signed: /yi L,� • l 0�e r� <br /> Applicant s (�D Sr � <br /> f Q n , Plumber <br /> �}'�U ("3 Madison WI <br /> 1 Address <br /> Address( l 0 <br /> as Ls <br /> Phone Phone <br /> APPROVAL <br /> date: 2/11/2015 Water/Sewer Manager: <br /> Yelor.Town of Windsor copy Pink CapractalPlumbercopy I <br /> Mlle:Office Copy Please attach any additional conditions to this application <br />