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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. w'24-D ( Date: 1 -)-6) - jt J , <br /> IT ivt C' 2724 0 t p. 5 hereby makes application for water service at the following location: <br /> (owner) n� `` <br /> Address: Prat rt e (Jcc LL Rc ■ Lot: ' <br /> Parcel No. Addition: Ut-)°\ 1 Iou.� <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: 1 r Size of Meter: S/ tiA4 <br /> Kind of Service: --'∎ Replacement <br /> Improvement Type of Material: Copper(preferred) HDPE PVC <br /> General Service: <br /> No. of Fixture Units: — No. of Floors: — Water Cooling? Flow '- qpm <br /> Other large water consuming appliances? Flow gpm <br /> Fire Service: <br /> No. of Private Hydrants: — Standby Storage:— qal <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: Ue ] an1es <br /> Address: McA t5 nn 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 to the publi ater system, but before any portion of eewwork is covered. <br /> Signed: /1i2L4 '�',/ /z- -/ . l Ja UeS— <br /> ? 11-e .L. <br /> icant % <br /> g4,i .71-fiisk_ng.cti3lv( <br /> Plumber y Z Ir(AA- <br /> Addr ss �3 715V Address <br /> -G6/ - /Inn (O6 - 222- AO <br /> Phone Phone <br /> APPROVAL <br /> Date: 7 29 -1 C Water/Sewer Manager: CS L.S ()il 1 <br /> White:Office Copy Yellow:Town of Windsor copy Pink:Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />