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APPLICATION FOR WATER SERVICE <br /> WINDSOR SANITARY DISTRICT NO. 1 <br /> Application No, „. ' j€ - `A,;t - (,1 / <br /> ,f sr i ;i E,2, ,.; Ho f r .:v hereby makes application for water service at the following'location: <br /> (Cwner) -., <br /> Address: [-1 w r } 1 ( rt ,4jt ° t1 . Lot _ y ....) r7i. _ Block <br /> Parcel.No 1 I Addition - t) el t I <br /> t. I t <br /> Type of Building: ( Single Family Multi-Unit Dwelling Commercial Industrial <br /> Note: If other than sirigle"1' ease 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 P dIMBE . <br /> Size of Connection: .1, -4',1/K f <br /> Size of Meter: � ' /4/ <br /> Kind of Service: i_ New Replacement - Improvement Type of Material: Copper Cast Iron <br /> (Owners Service) (Plastic w not 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$ ,...M.,.. <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:`- 'Tr.&\.J ,e> J t-i v r' <br /> Address:.. °i( rn Ci i U il <br /> REMARKS: Please note electrician to" nst"'talI 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 tho Wisconsin f SC. <br /> 2. To notify the"Water/Sewer Manager of Windsor Sanitary District No 1 when the water system is ready for inspection and <br /> n to the uV�IJ�{yi later system,but before any portion of the work is covered. <br /> Sign d ...,— . Ir <br /> pptiC'ant / ) Plumber <br /> � r. <br /> x C i, , f 1 a s= ' <br /> 1 Address Andress <br /> Phone Phone _. . d �` <br /> APPROVAL ,.-.., .ar ..� a ;: <br /> Date: { Aill. , a", i <br /> WaR. .M-".."r <br /> Whit.. c. —._ ._._.___ .-._�. <br /> Yellow.Town of Windsor <br /> Pink.Contractor Copy <br /> Gold s Plumber Copy <br /> Please attach an additional conditions to this a• .Iication. <br /> • <br />