Laserfiche WebLink
Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. -1 C) .°:?0 Date: X . i G . <br /> x1 JO 1 h"1 hereby makes application for water service at the following location: <br /> (owner) <br /> Address: < Lot: Lo <br /> Parcel No. Addition: <br /> Type of Building: Single Family Multi-Unit Dwelling l 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: f PA, 'V\ Size of Meter: I Kind of Service: New t Replacement <br /> Improvement Type of Material: Copper(preferred) HDPE PVC <br /> General Service: <br /> No. of Fixture Units: No. of Floors: Water Cooling? Flow qpm <br /> Other large water consuming appliances?Flow qpm <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: , .C° 7;,,,:>i7,r> � <br /> Address: <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 anager of Windsor Sanitary District#1 when the water system is ready for inspection and <br /> connection to the public ater system,but before any portion of the work is covered. <br /> Signed: .` /' ', + . �.. T. x 4 <br /> Applicant F - Plumber <br /> L61-4 g y <br /> t-'� �6-`1-'€3 c e (r(v,if'.... <br /> Address Address <br /> Phone Phone <br /> APPROVAL <br /> Date: w I .�s Water/Sewer Manager. _ <br /> L <br /> While:Office Copy Yellow:Town of Windsor copy PMh' Vector/Plumber copy <br /> Please attach any additional conditions to this application <br />