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1 <br /> l <br /> I <br /> g <br /> Application for Water Service <br /> o <br /> Windsor Sanitary District#1 <br /> l <br /> Application No. 5384 Date: July 15,2015 <br /> i <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Royal Artis Rd Lot: 267 <br /> ( <br /> Parcel No. --- Addition: Holland Fields <br /> 3 <br /> Type of Building: K 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/commerciaVindustrial buildings. <br /> 1 Multi-unit structure option chosen: No.1 No.2 <br /> i <br /> 3 <br /> t Size of Connection: 1: Size of Meter: 5/8 x 3/4 <br /> f <br /> I Kind of Service: X New Replacement <br /> I <br /> Improvement Type of Material: K 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 /> i <br /> Fire Service: <br /> No.of Private Hydrants: --- Standby Storage: --- gal <br /> 3 <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 toy the public water system,but before any portion of the work is covered. <br /> g Ue ` Gt-V'�o\ t c ,L . 't <br /> Signed: —9-- ('� Dave Jones Plumbing <br /> Applicant, O t JU�" - ��,� Plumber <br /> 4'} <br /> CA-kbaM t 67!3 Madison WI <br /> • Address Address <br /> { 406-- � (0 —3100 <br /> Phone Phone <br /> APPROVAL ) <br /> Date: July 15,2015 Water/Sewer Manager:C PP- <br /> I <br /> WhOe:Office Copy Yellow:Town of Windsor copy Pink:ConhactodNlum6ercnpy <br /> Please attach any additional conditions to this application <br /> i <br />