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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 4210 7 Date: - / /S— <br /> .i-r � J <br /> 1 I vvl C / �8ei enl ingS hereby makes application for water service at the following location: <br /> (owner) <br /> Address: pJS IC Li ie 0 Lot: 4. 7 7 <br /> Parcel No. Addition: (")al l /10//0 w <br /> Type of Building: SingleFamiillyr) 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: `11. k L/ <br /> Kind of Service: ( e ) 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-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: ri,`�, ..,A�,(1.e 5 pt�,,1 c1,; } <br /> Address: Y1.C.A,,,5;r1 ,---r--- <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: 7% Ti 5, r 4 ,(. <br /> Plant / ,\ / , <br /> 4/` /, .,, Plumber <br /> ,,f>l- 1, 5 j'ii( : F Il1. , % 1_... , <br /> / A r , C ) _�! i Address; : )1‘ :., <br /> Address <br /> /(1)r ` /i(,-l - / f/` r <br /> Phone <br /> /r( ) ?: - ( O <br /> APPROVAL Phone <br /> Date: -!;� i 5 Water/Sewer Manager:-\ C '�,... <br /> I White:Office Copy Yellow.Town of Windsor copy <br /> Please attach any additional conditions to this application Fmk.contreaor/Plumberrnpy I <br />