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Sewer Connection Application <br /> Windsor Sanitary District #1 <br /> Application No. (0 cO G Date: I 6- I " I <br /> T m O r I 14;:, in : hereby makes application for sewer service at the following location: <br /> (Owner) <br /> Address: Fru 1 f"i f e r - t n Lot: Q'.3 Block: <br /> Parcel No. Addition: <br /> Type of Building: Single Family Multi-unit dwelling Commercial Industrial <br /> Kind of Service: New Replacement Improvement <br /> Size of Connection: Type of Material 17 ■/ L <br /> Name and address of firm doing the proposed work: P a U r J <br /> cY} d 1 v r: 3 I... <br /> The customer is responsible for the cost of material and installation from the sewer main to the structure. If a road <br /> crossing is necessary, trenches in paved streets shall be refilled with compacted sand or gravel. There will be 6" <br /> deep concrete bridging placed over the excavation and 2" bituminous mixture (hot mix) placed over the concrete <br /> to match street grade. <br /> Remarks: <br /> In consideration of the granting of this permit the undersigned agrees: <br /> 1. To accept and abide by all provisions of the sewer use ordinances of the Madison Metropolitan <br /> Sewerage District and the Windsor Sanitary District#1 and all other pertinent ordinances or <br /> regulation that may be adopted in the future. <br /> 2. To maintain the building sewer at no expense to Windsor Sanitary District#1 <br /> 3. To notify the Town of Windsor Plumbing Inspector when the building sewer is completed and <br /> ready for inspection, but before any portion of the work is covered. <br /> 4. To install tracer wire and grounding rod in accordance with WSD# 1 ordinance. <br /> Remarks: <br /> Date: ;C Signed -" - 1/ n vi Yt..,,, <br /> (applicant) <br /> $ ([)(?(` Hookup fees paid. -• / n / / " / / i-, /, ,1./ SXe /4 <br /> (address of applicant) / 1 J /f,----)y-, 4d, <br /> ,■. z_±..._E--- 1\,. <br /> : iA /— //() L--- -7/Y <br /> Superintendent, clerk, etc.) (phone) <br /> CONDITIONS: <br /> I <br />