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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5394 Date: 8/10/2015 <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Dutch Diamond Way Lot: 257 <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/commerciandustrial 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: m <br /> No. of Fixture Units: --- No. of Floors: ---- Water Cooling? ---- Flow ---- gP <br /> Other large water consuming appliances? Flow --- qpm <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: 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. and <br /> 2. To notify the Water/Sewer Manager of Windsor Sanitary District#1 when the water system is ready for inspect <br /> connection tp =public ++aterrrs te[m,but before any portion of the work is covered. <br /> , <br /> Signed: AL_ I_.. _ _ _ Dave Jones Plumbing <br /> oo <br /> Plumber <br /> Applica( bO I S "�Dy.1A1Q Q')' <br /> !! ,. ` '., ,'.' - .� t f, Madison, WI <br /> Address Address <br /> LU - - 4 3 0 <br /> Phone Phone <br /> APPROVAL <br /> Date: 8/10/2015 Water/Sewer Manager: <br /> White:Office Copy Yellow:Town of Windsor Dopy <br /> Pink:Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />