Laserfiche WebLink
Application for Water Service <br /> Windsor Sanitary District#1 <br /> Application No. 5399 Date: 09/15/2015 <br /> Veridian Homes AB, LLC hereby makes application for water service at the following location: <br /> (owner) <br /> Address: Circle Tram Way Lot: 22 <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/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 — 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: 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 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 put}li water ystem,but before any portion of the work is covered. <br /> t-- 1�c tat pSf�� <br /> Signed: LGi:t Dave Jones Plumbing <br /> Applicant Plumber <br /> tli S C I S44 TAM d w,tc 114 .11444.4%,VP Madison,WI <br /> Address Address <br /> o ` c�- �j1 00 <br /> Phone Phone <br /> APPROVAL <br /> Date: 09/15/2015 • Water/Sewer Manager: Iv <br /> White:Office Copy Yellow:Town of Windsor copy Pink Contractor/Plumber copy <br /> Please attach any additional conditions to this application <br />