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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5397 Date: Sept. 1; 2015 <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Circle Tram Way _ Lot: 24 <br /> Parcel No. --- Addition: Holland Fields <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/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 --- 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: 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 lo the public water system,but before any portion of the work is covered. <br /> VeRStkit,1t ome <br /> ` n <br /> Signed:--- .. Dave Jones Plumbing_ — — <br /> Applica6t t 0 l+_ ns --0 Plumber — — <br /> k3 Madison WI -- — --Address 1 Address <br /> Phone Phone <br /> APPROVAL <br /> Date: Sept. 1, 2015 Water/Sewer Manager:edit- <br /> w-:8 0":ce Copy Ye cw:Tcw-c'W.-csc'copy P Cc^•ac:c•/P ccay <br /> Please attach any additional conditions to this application <br />