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Application for Water Service <br /> Windsor Sanitary District #1 <br /> Application No. 7021 Date: 9/292015 <br /> State at Main hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Prairie Creek Road Lot: 25 <br /> Parcel No. Addition: Prairie Creek Phase 2D <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 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: Janesville Plumbing <br /> Address: Janesville, 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 public water system,but before any portion of the work is covered. <br /> Signed: y/ Janesville Plumbing <br /> App it cant y Plumber <br /> ZOO IV /APTwd 5I Janesville,WI <br /> Address Address <br /> lo c — Ci >> — 34 s`5 <br /> Phone Phone <br /> APPROVAL <br /> Date: 9/292015 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 />