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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. ?, J Li Date: /J"02 °gyp/� <br /> 1 t (�)1_,i/A.. /If/1a hereby makes application for water service at the following location: <br /> (owner) <br /> Address: J-.A ! ' (2-1 try Lot: t-] <br /> Parcel No. Addition: <br /> Type of Building: in le 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- / `'/,/ <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 w_gpm <br /> Other large water consuming appliances? Flow gpm <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 /> Name: 1; . , •._\. , <br /> Address: t 1) _ ; ,_. . w'•. t',‘ <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 /> Sig e , - 1)14//r \I NE5 /AA- <br /> Appplirnt / \ Plumber ,, 1! ., `5 <br /> A c .//i/_ ! ',ti 7. ,-(4,- l . /-,/,,4)`1. /TA/ 1, l>' -5—;.-',,2/ 7-3 <br /> Address /) J ,_ ; ,s;,:._. ;'11 .. (f Address <br /> .47 r- (t ,//A7 ✓ /tor - 2 M' - 7`/ 2 <br /> Phone Phone <br /> APPROVAL , r--}' i <br /> { <br /> Date: \\ - c�L-:— i`( Water/Sewer Manager r 1 77r- -.�. <br /> White:Office Copy Yellow:Town of Windsor copy Pink'ofl rpctor/Plumber copy <br /> Please attach any additional conditions to this application <br />