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Sewer Connection Application <br /> Windsor Sanitary District#1 <br /> Application No. I`1 Date: /1- e25 i <br /> rr U c t r,; hereby makes application for sewer service at the following location: <br /> (Owner) <br /> Address: L `. `) L` ', Lot: Li Block: <br /> Parcel No. Addition: <br /> Type of Building: Single Family Multi-unit dwelling Commercial Industrial <br /> Kind of Service: New Replacement Improvement <br /> Size of Connection: ` I Type of Material ,\; C <br /> Name and address of firm doing the proposed work: Ti Nit r1 S 4' I tl , h j n�J <br /> The customer is responsible for the cost of material and installation from the sewer main to the structure. If a road <br /> crossing is necessary, trenches in paved streets shall be refilled with compacted sand or gravel.There will be 6" <br /> deep concrete bridging placed over the excavation and 2" bituminous mixture(hot mix)placed over the concrete <br /> to match street grade. <br /> Remarks: <br /> In consideration of the granting of this permit the undersigned agrees: <br /> 1. To accept and abide by all provisions of the sewer use ordinances of the Madison Metropolitan <br /> Sewerage District and the Windsor Sanitary District#1 and all other pertinent ordinances or <br /> regulation that may be adopted in the future. <br /> 2. To maintain the building sewer at no expense to Windsor Sanitary District#1 <br /> 3. To notify the Town of Windsor Plumbing Inspector when the building sewer is completed and <br /> ready for inspection, but before any portion of the work is covered. <br /> 4. To install tracer wire and grounding rod in accordance with WSD#1 ordinance. <br /> Remarks: <br /> Date: ; e Signed 114/,,4- <br /> a li nt <br /> / <br /> $ ,)Ls' Hookup fees paid. "7' ( r f j'<- '/ ) !I f l, /(!r ,�. <br /> (address of applicant) 1 �. y- -�(j .1rT `/ 7G'�f <br /> uBupeftendent, clerk, etc.) (phone) <br /> CONDITIONS: <br />