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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. <br /> Date: <br /> hereby makes application for water service at the following location: <br /> (owner) <br /> Address: <br /> Lot: <br /> Parcel No. Addition: <br /> Type of Building: 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/commerciaUindustrial buildings. <br /> Multi-unit structure option chosen: No. 1 No.2 <br /> Size of Connection: Size of Meter: `* <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 <br /> __ 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-top)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: • <br /> Address: <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 /> Signed: <br /> Applicant Plumber <br /> Address Address <br /> Phone Phone <br /> APPROVAL <br /> Date: Water/Sewer Manager: <br /> I White:Office Copy Yellow:Town of Windsor copy <br /> Please attach any additional conditions to his application Pink:Contractor/Plumber copy I <br />