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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5414 Date: March 5,2015 <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Heirloom Drive Lot: 251 <br /> Parcel No. -- Addition: Holland Fields <br /> Type of Building: X 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/commerciandustrial 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: <br /> No.of Fixture Units: --- No.of Floors: -- Water Cooling? --- Flow <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 /> 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 pi the pub water system,but before any portion of the work is covered. <br /> 2i <br /> V _(al t 1 4-L <br /> Signed: t6tf`e Y1ca 6-arc-Le -4-4044.4 Dave Jones Plumbing <br /> Applicant 4 g0 I Ski T wilit 01, Plumber <br /> Met-eQ,/,9d7 . ) S-5-7 l - Madison,WI <br /> Address Address <br /> Phone Phone <br /> APPROVAL //)��-- __ -- <br /> Date: March 5,2015 Water/Sewer Manager: Ifs <br /> White:Office Copy YeAow:TorYn of Wtdea copy <br /> Pink;Contactor Pturther copy <br /> Please attach any additional conditions to this application <br />