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Sewer Connection Application <br /> Windsor Sanitary District#1 <br /> Application No. (02°7 Date: cj —) e -1 S" <br /> `to 0 B,e7) t---c c'-wj hereby makes application for sewer service at the following location: <br /> (Owner) <br /> Address: D U S ky 6 je 1 Lot: Block: <br /> Parcel No. / Addition: !4o1 F Ho I (D i <br /> Type of Building: 'V Single Family Multi-unit dwelling Commercial Industrial <br /> Kind of Service: X New Replacement Improvement <br /> Size of Connection: ' Type of Material Q v i�_ <br /> Name and address of firm doing the proposed work: D e ,.'(j d'4',--P_.> 1"Y j6 J,y;,i (A <br /> The customer is responsible for the cost of material and installation from the sewer main to the structure. If a road <br /> crossing is necessary,trenches in paved streets shall be refilled with compacted sand or gravel. There will be 6" <br /> deep concrete bridging placed over the excavation and 2"bituminous mixture (hot mix)placed over the concrete <br /> to match street grade. <br /> Remarks: <br /> In consideration of the granting of this permit the undersigned agrees: <br /> 1. To accept and abide by all provisions of the sewer use ordinances of the Madison Metropolitan <br /> Sewerage District and the Windsor Sanitary District#1 and all other pertinent ordinances or <br /> regulation that may be adopted in the future. <br /> 2. To maintain the building sewer at no expense to Windsor Sanitary District#1 <br /> 3. To notify the Town of Windsor Plumbing Inspector when the building sewer is completed and <br /> ready for inspection, but before any portion of the work is covered. <br /> 4. To install tracer wire and grounding rod in accordance with WSD# 1 ordinance. <br /> Remarks: <br /> Date: S - r - I ��- <br /> 5 Signed / , / ).< ;_ / --` 1_ et,/ ,=t 11.1-----_— <br /> (applicant) r. J ) , <br /> $ (0 0 0,�Hookup fees paid. ` (/ <br /> (address of applicant) <br /> ,,,..,64,6 WS 0 ft- /1-- <br /> Su erintendent, clerk, etc.) (phone) <br /> CONDITIONS: <br />