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• <br /> • APPLICATION FOR WATER 'SERVICE <br /> 1/ WINDSOR SANITARY DISTRICT NO. 1 <br /> D <br /> Application No. (O Date: I-10-0 c <br /> Serf L rS v h hereby makes application for water service at the following location: <br /> (Owner)Address: Lot Block <br /> Parcel No. Addition L)//1 CIS ci r is); <br /> Type of Building: S Family Multi-Unit Dwelling Commercial Industrial <br /> Note: If other than single faml y, p ease attach description and drawing indicating type and layout of service desired. See <br /> reverse side for rules pertaining to multi-unit dwelling/commerciaVindustrial buildings. <br /> Multi-unit structure option chosen: No. 1 No. 2 <br /> TO BE COMPLETED BY MASIIR PLUMBER <br /> Size of Connection: Size of Meter: -�e x 3/4/ <br /> Kind of Service: New Replacement Improvement Type of Material: Copper Cast Iron <br /> (Owner's Service) (Plastic if-•rr6t be allowed) <br /> GENERAL SERVICE: <br /> No.of Fixture Units No.of Floors Water Cooling? flow 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 #1. <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: "_F C�r s 1 1Q re. S <br /> J <br /> Address: <br /> REMARKS: Please note electrician to Install 18-2 bell wire horn 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 notify the Water/Sewer Manager of Windsor Sanitary District No. 1 when the water system is ready for inspection and <br /> connection to the public water system, but before any portion of the work is covered. <br /> ' (s <br /> Signed /.:f) '!� t�, C) k % a'.,.1 b t <br /> Applicant / Plumber <br /> emo <br /> ________- <br /> Address Address <br /> --- ----- <br /> �; �? j <br /> Phone Phone <br /> APPROVAL. --- — <br /> Date: 6'' /CA-09 " �..... (1)_ ! <br /> 2' .Water/Sewer Manager <br /> White:oak.Copy -----— -- __— �—__------ •- <br /> Yellow.Town of Windsor <br /> Pink:Contractor Copy <br /> Gold a Plumber Copy <br /> Please attach any additional conditions to this application. <br /> At- <br />