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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5398 Date: August 24,2015 <br /> Veridian Homes AB, LLC hereby Makes application for water service at the following location: <br /> (owner) <br /> Address: Circle Tram Way Lot: 23 <br /> Parcel No. --- I 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/commercial/industrial 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: X 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 - 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 Iwork: <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 regul tions of Windsor Sanitary District#1 as filed with the Wisconsin PSC. <br /> 2. To notify the Water/Sewer Manager of Wi sor Sanitary District#1 when the water system is ready for inspection and <br /> con�sc tion to he public vi ter system,but efore any portion of the work is covered. <br /> Signed: Mi ,.f A ..=n..A.,- . _ Dave Jones Plumbing <br /> Applicant (P 6` _ ' Plumber <br /> Address 'v J 0 )T 's- t 3 Madison,,WI <br /> Address <br /> (4,0 <br /> Phone Phone <br /> APPROVAL <br /> Date: August 24, 2015 1 <br /> I Water/Sewer Manager: <br /> White:Office Copy Yellow:Town of Windsor copy Pink:Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />