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APPLICATION FOR WATER SERVICE <br /> WINDSOR SANITARY DISTRICT NO. 1 <br /> • Application No. ;, , Date: <br /> hereby makes application for water service at the following location: <br /> (Owner) <br /> Address: Lot Block <br /> Parcel No. Addition <br /> Type of Building: Single Family 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/commerciaVindustrial buildings. <br /> Multi-unit structure option chosen: No. 1 No. 2 <br /> TO BE COMPLETEDLY MASLR PLUM. 11 <br /> Size of Connection: Size of Meter: <br /> Kind of Service: New Replacement Improvement Type of Material: Copper Cast Iron <br /> (Owner's Service) (Plastic will not he 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: <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 wator system is ready for inspection and <br /> connection to the public water system, but before any portion of the work is covered. <br /> Signed 72., — — — — ---- — <br /> Applicant Plumber <br /> Address Address <br /> ,� (>1.0) � __ ------ --- <br /> Phone Phone <br /> APPROVAL <br /> Date: -- — — -- — <br /> Water/Sewer Manager <br /> White:Ot ice Copy --- ---. --.--- ------._�_._.__� <br /> Yellow. Town of Windsor <br /> Pink:Contractor Copy <br /> Gold= Plumber Copy <br /> Please attach an additional conditions to this application. <br />