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Sewer Connection Application <br /> Windsor Sanitary District#1 <br /> Application No, 5414 Date: March 5,2015 <br /> Veridian Homes AB, LLC hereby makes application for sewer service at the following location: <br /> (Owner) <br /> Address: Heirloom Drive Lot: 251 Block: <br /> Parcel No. — Addition: Holland.Fields <br /> Type of Building: X Single Family Multi-unit dwelling Commercial Industrial <br /> Kind of Service: X New Replacement Improvement <br /> Size of Connection: 4 inch Type of Material PVC <br /> Name and address of firm doing the proposed work: Dave Jones Plumbing <br /> Madison,Wi <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 /> V e dl t .�, 14-010 �-�- " <br /> Date: March 5,2015 Signed /"1 –Q <br /> (applicant) (2 Q a y�� `�- S�Q I1 <br /> $,OO.OUiookup fees paid. rn 4-(x- 4 s ( <br /> (address of applicant) <br /> / ri (1144. Coe ( 'a` 310 c7 <br /> (` erintendent,clerk,etc.) (phone) <br /> CONDITIONS: <br />