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APPLICATION FOR WATER SERVICE , <br /> WINDSOR SANITARY DISTRICT NO. 1 <br /> Application No. ,3" Date: 7-.20–O el , <br /> Ve. r Gr l Ct.A-- hereby makes application for water service at the following location: <br /> Address: (Ome� Lot , 1 I Block. <br /> Parcel No Addition - d o itIa ? <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 desired. See <br /> reverse side for rules pertaining to multi-unit dwelling/commercial/industrial buildings. <br /> Multi-unit structure option chosen: No..1 No 2 <br /> TO BE COMPLETED BY MASTER PLUMBER <br /> !■ /. <br /> Size of Connection: � Size of Meter. <br /> Kind of Service: New-). Replacement Improvement Type of Material: 'Copper Cast Iron <br /> (Owner's Service) (Plastid-noti allowed) <br /> GENERAL SERVICE: <br /> No of Fixture Units " No of Floors Water Cooling? now _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 /> OUTSIDE WATERING (Separate meter for non-sewered use only) <br /> Size: Cost of Meter is$ <br /> NOTE: It is the responsibility of the plumber to pick up the water meter from the WSD #t. <br /> The Customer Is responsible for the cost of Installation (lateral & curb-stop) if It is necessary to 'Install <br /> service from the water main to the property line. <br /> Name of person or firm who will do the proposed work: <br /> Name• c....�N.)-47.....- <br /> Address: <br /> REMARKS: - Please note electrician to .Install 18-2 bell wire from the water service to beside electric or gas <br /> meter. <br /> ATTN PLUMBER: A union will be Installed beyond the first valve to enable the utility to gain access to the <br /> lateral In the event of freezing. <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 No 1 as filed with the Wisconsin PSC. <br /> 2. To not fy th Water/Sewer Manager of Windsor Sanitary District No 1 when the water system is ready for inspection and <br /> co mto the pu eaten,but before any portion of the work is covered. <br /> Signe M- - , . ...- \ <br /> pp scant Plumber <br /> Address Address— - -- ------�---- <br /> Phone <br /> APPROVAL /-ph --- --- <br /> Date: --'2•.f.)' - <br /> "Water/Sewer.Manager' <br /> Whir..Othc.Co' <br /> Yellow..Town of Windsor <br /> Pink:Contractor Copy <br /> Gold. Plumber Copy <br /> Please attach an additional conditions to this a• •Iicatlon. <br />