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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5416 Date: May 20,2015 <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: 1eirloom-1914Me Y;AA O a l7u r <br /> 14t144( Lot: 249 <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/commerciaVndustrial 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 — gpm <br /> Other large water consuming appliances?Row— cipm <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 /> n 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 ; is water pystem,but before _arty portion of the work is covered. <br /> , /,an o S LLB <br /> Signed: ,(/4,f Dave Jones Plumbing <br /> Applicant (�$0Jy� �t6` fOLI Plumber <br /> Address M�� 1 -c 379 Madison,WI <br /> Address <br /> (poi G -3l00 <br /> Phone Phone <br /> APPROVAL \ �� <br /> Date: May 20,2015 Water/Sewer Manager: , t1 U t- Uis) tk I <br /> L Whim:oreco Copy Yellow Town of Windsor wpp t�Pinic Contradar/numbercoPY <br /> Please attach any additional conditions to this application <br />