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CONTRACT <br /> SEWER CONNECTION APPLICATION <br /> WINDSOR SANITARY DISTRICT NO. 1 <br /> Application No.�3 Dh Date / y- 09 <br /> �gSor Le,.tzar._ hereby makes application for sewer service at the <br /> (Owner) <br /> following location: <br /> Address Lot (c) Block <br /> Parcel No. Addition/2),, jar Pr c 1? <br /> Type of Building: vSingle Family Multi-unit dwelling <br /> Commercial Industrial <br /> Kind of Service: (/ New Replacement Improvement <br /> N( <br /> Size of Connection: t7 Type of Material P V C..- <br /> Name and address of firm doing the proposed work: <br /> 1-v t-e <br /> sk p 1 ., <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 c-/ 7 ` O / Signed L / Z41611-/ <br /> Q,, plicant) <br /> $600 �' Hookup fees paid. Va, 5- <br /> cie4ie <br /> Application approved: address of applicant-r---- <br /> Date F146 0 S -3-2 74/ <br /> (phone) <br /> perri. ndent, lerk, etc.) <br /> CONDITIONS: <br />