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• <br /> Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5387 Date: 3/30/2015 <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Dutch Diamond Way Lot: 264 <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/commercial/industrial 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 — qP <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: 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 t' the publiqvyater system,but before any portion of the work is covered. <br /> Signed: av,e./41 �i�� Dave Jones Plumbing <br /> Appli p, DI /p( V,�f Plumber <br /> ' <br /> t O OLL<L TI w -53)13 Madison,WI <br /> Address / Address <br /> tco -310D <br /> Phone Phone <br /> APPROVAL <br /> Date: 3/30/2015 Water/Sewer Manager: �' <br /> . <br /> I White:Office Copy Yellow:Town of Windsor coPY Pink:Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />