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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5406 Date: May 18,2015 <br /> Veridian Homes Ab,LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Dutch Diamond Wav Lot: 242 <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: K Copper(preferred) HDPE PVC <br /> General Service: <br /> No.of Fixture Units:--- No.of Floors: -- Water Cooling? — Flow — 4pm <br /> Other large water consuming appliances?Flow— gpm <br /> Are 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 the (ic ter stem but fore any portion of the work is covered. <br /> r 'e�cca ', c»?As c C <br /> Signed: ',4_ kites .>c��.c_ Dave Jones Plumbing <br /> Applicant Plumber <br /> 4 86 t I-Mk Ai, <br /> yhit.1.1 ; v■ it1 53-7 I 3 Madison,WI <br /> Address f Address <br /> n e Phone <br /> 18- 4C (f - -4 I C)D APPROVAL <br /> Date: May 18,2015 Water/Sewer Manage _ . _ _ ,*C41-) <br /> Wlvte:Office Copy Yellow:Town of Windsor copy Pink Contractor/PlumbContractor/Plumber coPY <br /> I Please attach any additional conditions to this application <br />