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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. t-1-7 3 Date: ✓1 I 2.(1.;IS <br /> /Nat /i i-p y, hereby makes application for water service at the following location: <br /> (owner) 1 <br /> Address: Mel voceA Lane Lot: / <br /> Parcel No. Addition: tfri,ra Se r Cc.. ier'S <br /> Type of Building: 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: / Size of Meter: $`/e / 3/4/ <br /> Kind of Service: New" Replacement <br /> Improvement Type of Material: 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? 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: ^ v <br /> Address: <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: <br /> Applicant Plumber <br /> l6� .:7"'se, C,-.olei L - <br /> Address 4e.sofc, Address <br /> (847J ;0-06.73 <br /> Phone Phone <br /> APPROc C„ <br /> Date: <br /> ri‘l2-6 I.S Water/Sewer Manager: ( us.04- I <br /> White:Office Copy Yellow:Town of Windsor copy Pink:Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />