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CONTRACT <br /> SEWER CONNECTION APPLICATION <br /> WINDSOR SANITARY DISTRICT NO. 1 <br /> Application No. 534 5 Date 1- (2Q -C� <br /> hereby makes application for sewer service at the <br /> (Oiner) <br /> following location: <br /> Address Lot J.) I Block <br /> Parcel No. Addition i4 o 4 t a.a..( 1.p1ems. <br /> Type of Building: j - ingle Family Multi-unit dwelling <br /> Commercial Industrial <br /> Kind of Service: Replacement Improvement <br /> Size of Connection: <br /> t <br /> Li Type of Material <br /> Name and address of firm doing the proposed work: <br /> o�,.��JQ h.Q S t 1 V...,1 u:..( • <br /> The customer is responsible for the cost of material and installation from the <br /> sewer main to the structure. If a road crossing is necessary, trenchs in paved <br /> streets shall be refilled with compacted sand or gravel. There will be 6" deep <br /> concrete bridging placed over the excavation and 2" bituminus mixture (hot mix) <br /> placed over the concrete 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 <br /> of the Madison Metropolitian Sewerage District and the Windsor <br /> Sanitary District No. 1 and all other pertinent ordinances or <br /> regulations that may be adopted in the future. <br /> 2. To maintain the building sewer at no expense to Windsor Sanitary <br /> District No. 1. <br /> 3. To notify the Town of Windsor plumbing inspector when the building <br /> sewer is completed and ready for inspection, but before any portion <br /> of the work is covered. <br /> REMARKS: <br /> Date J" a.O- Q Sign �J -C yC— ^� <br /> (applicant <br /> $ (¢ cs-v Hookup fees paid. <br /> Application approved: (address of applicant) <br /> Date -2,,,U <br /> (phone) <br /> t4, <br /> su rintendent, erk, etc.) <br /> CONDITIONS: <br />