Laserfiche WebLink
APPLICATION FOR WATER SERVICE <br /> � <br /> n WINDSOR SANITARY DISTRICT NO. 1 <br /> Application No.�v `'' Date: 3- —O CJ <br /> hereby makes application for water service at the following location: <br /> Address: ( r) Lot _ I - Block <br /> Parcel No. _ Addition I ra_o f't p pe c <br /> Type of Building: 's - - 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 MASIER PLUMBER <br /> Size of Connection: 1 Size of Meter: S/S,"/ <br /> Kind of Service: New, Replacement Improvement Type of Material: Coppery Cast Iron <br /> (Owner's Service) (Plastic will not be allowed) <br /> GENERAL SERVICE: <br /> No.of Fixture Units No.of Floors Water Cooling? `low _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: ,-i) ooue 0tiNe"a <br /> Address: <br /> REMARKS: Please note electrician to install 18-2 bell wire hom 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 pf 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 /> r 1 �t5 �AI�Q S <br /> Signed ,. - f ,��t.t7�. ,,� (_ -./ .- ".�------- ------ --- <br /> Applicant Pfumber <br /> Address Address - _—_---------- — <br /> Phone ;;;,7--�--- --- <br /> APPROVAL <br /> Date: 3- 23 �J <br /> ter/Sewer Manager <br /> "tts Ut$ce Coppy C•--- <br /> Yellow.Town of Windsor <br /> Pink:Contractor Copy <br /> Gold: Plumber Copy <br /> Please attach any additional conditions to this application. <br />