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` ' APPLICATION FOR WATER E <br /> S RVICE <br /> WINDSOR SANITARY DISTRICT NO. 1 <br /> Application No. (-) Date: / _ I u.= <br /> \\/ I <br /> ° (Y\ hereby makes application for water service.at the following location: <br /> Address: ( � , xy. i? " C ')' Lot I - 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. 11 No. 2 <br /> TO BE COMPLETED BY MASTER_PLUMBER <br /> Size of Connection: Size of Meter: w> ` . ..�.�1� <br /> Kind of Service: New Replacement Improvement Type of.Material: Copper Cast Iron <br /> (Owner's Service) (Plastic wit 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 _Fire Pump?Pump?` -. Flow gpm. Sprinkling System _Flow gpm <br /> OUTSIDE WATERING (Sepafate teeter for non=sewered use only) <br /> Size: <br /> Pogo(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 responalblo 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`t;A,1 ; ,-) r c‘`) <br /> Address: 1Y\ ( ! .. _ ?�` <br /> REMARKS: Please note electrician to 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 gein 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 NC. <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'Atha work is covered. <br /> Signed 01 t rRL -- _-- <br /> Applicant 1 Plumber <br /> 41801 e-:x3t icc,u ..•/ M t, ;.,� �.1 e ti <br /> Address Address <br /> 2..21, - 3100 . <br /> Phone Phone <br /> APPROVAL �' t r` <br /> Date: <br /> Wat OE- rl anager - <br /> V1hft. Ctlltc�lire ; _ __. <br /> Yellow.Town of Windsor <br /> Pinks Contractor Copy <br /> Gold Plumber Copy <br /> Please attach an additional conditions to this a• •llcatlon. <br />