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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5405 Date: May 20,2015 <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Dutch Diamond Way Lot: 241 <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: K 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 — 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: 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 tq I public Rater system,but before any portion of the work is covered. <br /> Vt ' ' L aq f-t0 -4 L1-C;, <br /> Signed: ► ,.. , , Dave Jones Plumbing <br /> Applicant 60' 4.1A," To-1011)0 Plumber <br /> Address ' I`�4 " w S fl/9 Madison,WI <br /> / Address <br /> ( .0°8 I00 <br /> Phone Phone <br /> APPROVAL <br /> Date: May 20,2015 Water/Sewer Manager: l 'i– (4)5D* <br /> White:DHfce Copy Yellow:Toxin of Windsor copy Pink ConsactodPkrnber cop <br /> Please attach any additional conditions to this application <br />