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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. i4-/ I`' Date: z-;,. _. <br /> j ‘ r:� 1,J F f \'r r} 4 aft;, r_ hereby makes application for water service at the following location: <br /> (owner) <br /> Address: -1)1/:_._}, y !-, - Lot: <-, -7,1 <br /> Parcel No Addition: : '1 ,, , t i <br /> - l <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/commercial/industrial buildings. <br /> Multi-unit structure option chosen: No. 1 No.2 <br /> Size of Connection: _i. 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 _ qpm <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: , - ,r i-' I , <br /> Address: }: ; 'i , -I/ <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: f /;'I ,* ✓ -- -Zit i„�r'z----_ — <br /> �.. I <br /> Plumber A Pt' / t? / `a w °% f /� t f .{ . <br /> Address Address <br /> .n t: //-- //(O <br /> Phone Phone <br /> APPROVAL <br /> Date: _- - /--,O !'% Water/Sewer Manager ) ^ f � ` ter; ,• <br /> White:Office Copy Yellow Town of Windsor copy Pink Contractor/Plumber copy '4 <br /> Please attach any additional conditions to this application <br />