Laserfiche WebLink
Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. Date: 0 - I - <br /> hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Lot: <br /> Parcel No. Addition: <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.. / Size of Meter: <br /> Kind of Service: New Replacement <br /> Improvement Type of Material: 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: DG \J Q 0 n f S <br /> Address: '(1'1 c, A <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 (A_ /101/ l D�LfF Ly -4 .'-� _.P' v e <br /> Applicant ti Plumber <br /> 0,t,o/7915 CG7,/S o -cit I <br /> Address /,>.-Z'y) Address <br /> Phone Phone <br /> APPROVAL <br /> I Date: 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 />