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Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5396 Date: 8/17/2015 <br /> Veridian Homes AB,LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Circle Tram Way Lot: 25 <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/commerciaVindustrial buildings. <br /> Multi-unit structure option chosen: No.1 No.2 <br /> Size of Connection: 1" Size of Meter: 5/8 x 3/4 <br /> Kind of Service: K New Replacement <br /> Improvement Type of Material: K 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 PSC. and <br /> 2. To notify the Water/Sewer Manager of Windsor Sanitary District#1 when the water system is ready for inspection <br /> connection otthe pu lic water system,but before any portion of the work is covered. <br /> t 4n 'LLB Dave Jones Plumbing <br /> Signed: �to�`eYtc�e rY'I`y <br /> p C Q Plumber <br /> Appli 0 �ivig tow <br /> �i (3 Madison,WI <br /> �� � ��/ <br /> Address Address <br /> (DO g,-D-D-co -3 t OD <br /> Phone Phone <br /> APPROVAL <br /> Date: 8/17/2015 Water/Sewer Manager. 1 <br /> White:Office Copy Yellow:Town of Windsor copy Pink:Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />