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• <br /> APPLICATION FOR WATER SERVICE <br /> WINDSOR SANITARY DISTRICT NO. 1 <br /> Application No. .4 r. ° ' 7 Date: /0 - 6 0'y <br /> t r ; (l ;c: h t } , _c hereby makes application for water service at the following location: <br /> (Owner) <br /> Address: i Y1 c'l i Lk,' 0`1 Lot -� 1 _, Block <br /> Parcel No. Addition H° 0 i I(; :1 ill - r f t 0 ' <br /> tea. . <br /> Type of Building: ;--Single Famil r Multi-Unit Dwelling Commercial Industrial <br /> Note: If other than single faintiy,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 COMPLETED BY MASTER PLUMBER <br /> rt f <br /> Size of Connection: i Size of Meter: ; F f ' <br /> Kind of Service:("Hew,) Replacement Improvement Type of Material: ;-"/Copper Cast Iron <br /> -' n ¢ (Owner's Service) (Plasticnot be allowed) <br /> GENERAL SERVICE; <br /> No.of Fixture Units No.of Floors Water Cooling? now - 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 u.... 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) It 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: G eft .\ C> n F C <br /> Address: YA C;,,(1 -ti S 0 v 1 4 LI <br /> REMARKS: Please note electrician lo Install 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 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 /> Signed " 1 ' — ;',4 ,"/ — <br /> Ap icar ! } Rumba- <br /> ,, <br /> ( 'i�1....-1;‘(:7„11:-. fir }r/ ( , f it�..-- V l? '�, c).. d.t - _ t <br /> Address I_ `,f,t r°`:.. �L. /. 2_ . �, .,,�,` Address <br /> =) , 1 :/ .. <br /> Phone - Phone —'-- -- <br /> APPROVAL I T.-.) f -- f <br /> €'fie <br /> Date: (r) ' (( - �J :f i � ,-i��,,;{`�' <br /> Watei eirw ?itvianaber <br /> *hit,;0111c.copy r v -� C ter. - <br /> Yellow.Town of Windsor <br /> Pink.Contractor Copy <br /> Gold: Plumber Copy <br /> Please attach an additional conditions to this a. •Ilcatlon. <br />