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HomeMy WebLinkAboutLat_14188PeriniAvenueLdVdsa ?ravel Stops June 22, 2016 10601 North Pennsylvania P.O. Box 26210 Oklahoma City, OK 73126 Gordon Attn: Jason Gerhart 301 N. Mildred Street, Suite 1 Charles Town, WV 25414 RE: Sewer Department Review Fee and Sewer Allocation Fee — Hagerstown, MD Dear Jason, Enclosed please see the Love's Travel Stops and Country Stores Inc. two checks payable to the Washington County Treasurer. The first check is in the amount of $700.00 for sewer department review fee at Hagerstown, MD. The Second check is in the amount of $319,600 for the sewer allocation at Hagerstown, MD. You may contact Rick Shuffield at 405-302-6646 or rick.shuffield@loves.com if you have questions. Sincerely, ti— Michelle L. Wright Administrative Assistant Cc: Rick Shuffield (800) 388-0983 / www.loves.com / "clean places, friendly faces" Washincyton County, Maryland "epartm ent of -Water Qual ltv I Cit ',? Elliott i'arkwav l� illiarnshort, NID 21?95 241), 3 l 3.2-0 PUBLIC \\-A'TERISE\N'ER SYSTE1\1 CONNECTION PERMIT Enter permit number 15475 Access Permit No. Permission is hereby given to: Property Owner: LOVES - JASON GERHART Applicant: LOVES -JASON GERHART Street: 301 N. MILDRED ST. SUITE 1 City: CHARLES TOWN State: WV Zipcode:25414 Connection Type (Residential I Commercial): COM Service Type: SEWER Service Area: Maugansville/Orchard Hills Service Code: 15o Additional Remarks: Equipment notes (pump type, etc): NA Fees paid in full? YES Date fees paid: 06/22/2016 DWQ connection fee: 84600.00 Misc. connection fees: 0.00 City fees paid to: NA City fees amounts ^.^__ oC j Qio-00 TOTAL FEES CHARGED: -"99T11-9 3 61 UW.00 For property located at: Street: 14188 PERINI DRIVE City: HAGERSTOWN State: MD Zipcode:21740 Needs connected to Lateral (YES I NO)? NA Permit No.: 5475 Issued Date: 07/05/2016 *Void Date: 07/05/2017 Is the property in a subdivision? NA Subdivision Name: NA Subdivision lot no.: NA Subdivision phase: NA Subdivision section: NA Type of EDU: COM Number if EDUs: 47 Gallons/day allocation: 9400 Additional Remarks: NA *Connection related comments: This permit is good for one (1) year from issuance date. A fee differential may be charged to reflect allocation fee increases if property is not connected by the permit void date. Owner must contact Asst. Superintendant of Maintenance Tom Barnhart at 240- 313-2600 at least 72 hours in advance of making the connection. When connecting to a public water/sewer system, the installation of the connection and the abandonment of the previous private system shall conform with the provisions of Maryland state laws and County policy. This permit does not supercede any local ordinance that is in effect with regard to road excavation, plumbing permits, etc. ALL OTHER PERMITS, kATE AND LOCAL, MUST BE OBTAINED BY TH PROPERTY OWNER AND ALL RESPONSIBILITY CONNE D THERE WIMAI WITH THE PROPERTY OWNE Sig V1� Date: 5 �y INSPECTIO : At lease 48 hours notice prior to requested date is required. ON SITE INSPECTION will be made by: Washington County Plumbing Board 80 W. Baltimore Street Hagerstown, MD 21740-4727 Phone: 240-313-2460 Inspection Date: Plumbing Inspector: IVR/Activity No: 2016-01717 Project No: P2016-0472 Permit Type: NR -NEW Inspector Area: B2 WASHINGTON COUNTY ujc,+,e„v- avej-,� BUILDING & ZONING PERMIT Applied: 04/14/2016 Approved: Status: PENDING District/Acct No: 13016666 Job Address: 14188 PERINI AVENUE HN� Location: SP -16-009 14188 PERINI AVENUE Parcel No: 024-10-0470-00000 _\ Zoning Dist: HIGHWAY INTERCHANGE v C� Floodplain: C Applicant: GERHART JASON 301 N MILDRED ST SUITE 1 CHARLES TOWN WV 25414 Phone Number: 304-725-8456 Owner: PERINI INDUSTRIAL LAND LLC Contractor: O01, Phone Number: 1- I Contractor Lic. No: o� Description: —J�IQ� 12,805 SQ FT ONE STORY COMMERICAL BUIL ING ON CONCRETE SLAB TO BE UTILIZIED AS "LOVE'S TRAVEL STOPS", A CONVENIENCE STORE AND FUELING STATIONS TO INCLUDE A "SUBWAY" RESTAURANT AND A "WENDY'S" RESTAURANT. ZONING CERTIFICATION FOR "LOVE'S TRAVEL STOPS", HOURS OF OPERATION WILL 24 HRS/DAY, 7 DAYS/WEEK, NUMBER OF EMPLOYEES WILL BE 14. ZONNG CERTIFICATION FOR "SUBWAY", HOURS OF OPERATION WILL 24 HRS/DAY, 7 DAYS/WEEK, NUMBER OF EMPLOYEES WILL BE 8. ZONING CERTIFICATION FOR "WENDY'S", HOURS OF OPERATION WILL BE 24 HRS/DAY, 7 DAYS/WEEK, NUMBER OF EMPLOYEES WILL BE 12. VISTA BUSINESS PARK -LOVE'S TRAVEL SHOPS Foundation Size: 153X92 Type of Heat...: Public Sewer...: Y Public Water...: Y Gas ............: Y Electric.......: Y Construction Valuation: $3,000,000.00 Code Enforced: 2012 INT'L BUILDING CODE Decorative Heating Appliance: Setbacks Lot Tract Area Lot Area Per Family Front Yard Setback Rear Yard Setback Left Side Setback Right Side Setback Lot Width Exterior Finish: BRICK Air Conditioning: Y Septic ....................: N/A Time Existed: N/A Well ........................ N/A Time Existed: N/A Construction Type: COM No. Of Bathrooms: No. of Half Bathrooms: ?? No. of Bedrooms: 0 Proposed 90 452 535 15 0 Minimum Required 40 10 10 10 0 RECEIVED APR 18 2016 WASHINGTON COUNTY DIVISION OF ENV MNGT This permit has been reviewed by the Washington County Permitting Department and meets all applicable local and state codes and ordinances. Should you have any questions, please contact our b WASHINGTON COUNTY BUILDING & ZONING PERMIT IVR/Activity No: 2016-01720 Project No: P2016-0472 Permit Type: NR -NEW Inspector Area: B2 Job Address: 14188 PERINI AVENUE HN Location: SP -16-009 14188 PERINI AVENUE Parcel No: 024-10-0470-00000 Zoning Dist: HIGHWAY INTERCHANGE Floodplain: C Applicant: Phone Number: Owner: Contractor: Phone Number: Contractor Lic. No: GERHARTJASON 301 N MILDRED ST SUITE 1 CHARLES TOWN WV 25414 304-725-8456 PERINI INDUSTRIAL LAND LLC Applied: 04/14/2016 Approved: Status: PENDING District/Acct No: 13016666 Description: 7830 SQ FT ONE STORY COMMERICAL BUILDING WITH A 776 SQ FT MEZZANINE ON CONCRETE SLAB TO BE UTILIZIED AS "LOVE'S TIRE SHOP", REPAIR OF TIRES AND SALE OF TIRES. ZONING CERTIFICATION FOR "LOVE'S TIRE SHOP", HOURS OF OPERATION WILL 24 HRS/DAY, 7 DAYS/WEEK, NUMBER OF EMPLOYEES WILL BE 4. VISTA BUSINESS PARK -LOVE'S TRAVEL SHOPS Foundation Size: 7830 Exterior Finish: METAL/BRICK SQ FT Air Conditioning: Y Type of Heat...: Septic ....................: N/A Public Sewer...: Y Time Existed: N/A Public Water.... Y Well .......................: N/A Gas ............: Time Existed: N/A Electric.......: Y Construction Type: COM Construction Valuation: $500,000.00 No. Of Bathrooms: Code Enforced: 2012 INT'L BUILDING CODE No. of Half Bathrooms: ?? Decorative Heating Appliance: No. of Bedrooms: 0 Setbacks Lot Tract Area Lot Area Per Family Front Yard Setback Rear Yard Setback Left Side Setback Right Side Setback Lot Width Proposed 504 59 585 23 0 Minimum Required 40 10 10 10 0 This permit has been reviewed by the Washington County Permitting Department and meets all applicable local and state codes and ordinances. Should you have any questions, please contact our department at 240-313-2460 between the hours of 7:30 a.m. through 4:30 p.m., Monday through Friday. 80 West Baltimore Street, Hagerstown, MD 21740 Phone: 240-313-2460 Fax: 240-313-2461 of'"C" Washil ton County, Maryland Department of -Water Quality 162'1' Elliott Park��av it l ial11sp��rt, N"lD ? f i4i i r1.,, 24 11.31' 2600 PFJ BLt C NNATER/SEW ER SYSTEM CONNECTION PERMIT Enter permit number 5475 Access Permit No. Permission is hereby given to: Property Owner: LOVES - JASON GERHART Applicant: LOVES -JASON GERHART Street: 301 N. MILDRED ST. SUITE 1 City: CHARLES TOWN State: WV Zipcode:26414 Connection Type (Residential I Commercial): COM Service Type: SEWER Service Area: Maugansville/Orchard Hills Service Code: 150 Additional Remarks: Equipment notes (pump type, etc): NA Fees paid in full? YES Date fees paid: 0612212016 DWQ connection fee: 84600.00 Misc- connection fees: 0.00 City fees paid to: NA City fees amount=9999 4135r ocC <)- U(� TOTAL FEES CHARGED:89 For property located at: Street: 14188 PERINI DRIVE City: HAGERSTOWN State: MD Zipcode:21740 Needs connected to Lateral (YES I NO)? NA Permit No.: 5475 Issued Date: 07/0512016 "Void Date: 07/0512017 Is the property in a subdivision? NA Subdivision Name: NA RECEIVED Subdivision lot no.: NA Subdivision phase: NA Subdivision section: NA DEC 19 2016 Type of EDU: COM Number if EDUs: 47 Gallons/day allocation: 9400 WASHINGTON COUNTY Additional Remarks: DIVISON OF ENV MNGT NA 'Connection related comments: This permit is good for one (1) year from issuance date. A fee differential may be charged to reflect allocation fee increases if property is not connected by the permit void date. Owner must contact Asst. Superintendant of Maintenance Tom Barnhart at 240- 313-2600 at least 72 hours in advance of making the connection. When connecting to a public water/sewer system, the installation of the connection and the abandonment of the previous private system shall conform with the provisions of Maryland state laws and County policy. This permit does not supersede any local ordinance that is in effect with regard to road excavation, plumbing permits, etc. ALL OTHER PERMITS, kATE AND LOCAL, MUST BE OBTAINED BY TH P OPERTY OWNER AND ALL RESPONSIBILITY CONNE D THERE WI MA WITH THE PROPERTY OWNER. Sigma Date: INSPECTIO : At lease 48 hours notice prior to requested date is required. ON SITE INSPECTION will be made by: Washington County Plumbing Board 80 W. Baltimore Street Hagerstown, MD 21740-4727 Phone: 240-313-2460 Inspection Date: Plumbing Inspector: Water Usage History o 00 0 ,�c•+ rr%r\ivJvvvn 1 n , v uvv� BORDENTOWN, NJ 08505 0 (609)298-2121 Ext; 16 M n www.cityofbordentoLn.com Pco in ACCOUNT INFORMATION I 5208-0 ACCOUNT NO: 2008 ROUTE 206 LOCATION: 10/01/15 BILLING DATE: 11/01/15 DUE DATE: II CURRENT,METER ACTIVITY PREVIOUS READING. CURRENT READING WATER 06/08/15 9110 08/30/15 9220 COMPOUND 06/08/15 9787 08/30/15 648 »CURRENT,CHAR6ES�DETARF DESCRIPTION UNITS f LAT USAGE 4 COM 1.00 696.25 2,908.20 Water Usage History o 00 0 -. 0 M n Pco in WATER BILL "AMOUNT DUE " LAST PAYMENT: DATE: 07/27/15 AMOUNT: 3,349.45 WATER PREVIOUS BALANCE: 0'45 CURRENT CHARGES: 3,604.45 0.00 INTEREST:. 3,604.45 TOTAL DUE: SPECIAL MESSAGE USAGE The City of Bordentown Water Utility is now accepts Water Bil 110000 fee for oLine nline paymentsments at ywillll be assessed by theconvenience payment 861000 processing company. The Consumer Confidence Report is available on the City's. website and can be found on the Water Utility tab. Each year the Consumer Confidence Report will be posted on the website on or before July 1 and will no longer be mailed. A ' reminder of the availability of the report will be included on TOTAL your water bill. 3,604.45 2014 2014 2015 2015 2015 PAYMENT COUPON - PLEASE DETACH AND RETURN THIS PORTION ALONG WITH YOUR PAYMENT NT DUE ACCOUNT INFQRMA TION - AMOU DUE DATE: 11/01/15 ACCOUNT NO: 5208-0 CURRENT DUE: 3,604.45 LOCATION: 2008 ROUTE 206 INTEREST: 0'00 BILLING DATE: 10/01/15 f TOTAL DUE: 3,604.45 NAME: LOVES TRAVEL STOPS&COUNTRY AMOUNT ENCLOSED CHECKSPAYABLE-TO: CITY OF -BORDENTOWN WATER DEPARTMENT j 324 FARNSWORTH AVENUE BORDENTOWN, NJ 08505 CTRL ID = US16-0001VZT5 MAYOR & CITY COUNCIL OF CUMBERLAND MD Account 4 / Customer @ 690794002 16487 Meter Readings Bill Date 5/26/16 Previous Balance 2,507.33 Penalties Adjustments UTILITY BILL Service Address 13300 ALICIHAN RD Service P©nod IF 4/25/16 5/23/16 P 4/25/16 5/23/16 P 4/25/16 5/23/16 Payments Received 2,507.33 - Balance at Blliing Current Billing Water 857.48 Sewer 2,012.03 Trash 19.78 BayReetFee 116.15 Current Charge 3,005.44 Balance Due 3,005.44 Due Date 6/16/16 We accept Mastercard, visa, CRT TO KNOW YOUR NEIOHBORB: 57 N. LIBERTY ST. CUMBERLAND, MD 21502 Unit of Usage Measure 20800 CFM 3000 CFM 230 CPM MAY 31 2016 QUESTIONS? IF ACCOUNT CONTAINS ANY AMOUNT THAT CALL 301-759-8409 OR VAT OUR IS 45 DAYS FROM THE BILL DATE, SERVICE WEBSITE AT WILL BE TERMINATED. www.cumberlandmc 3ov Rates available at WE >SITE View Cumberland's Annual Water Quality Report online in Adobe PDF form at: httnJAlnyurl.com/cpshwod Please call 301-759-6604 If you would like a paper copy of th - Annual Water Quality Report mailed to your home. After Due Date 3,065.55 Discover, 6 Debit at City Hall JOIN WWW.NE7CTDOOR.COM WHEN PAYING BY MAIL - ENCLOSE SECTION BELOW TO ENSURE PROPER CREDIT READS Days Previous Current 28 88900 109700 28 6100 9100 20 1570 1800 57 N. LIBERTY ST. CUMBERLAND, MD 21502 Unit of Usage Measure 20800 CFM 3000 CFM 230 CPM MAY 31 2016 QUESTIONS? IF ACCOUNT CONTAINS ANY AMOUNT THAT CALL 301-759-8409 OR VAT OUR IS 45 DAYS FROM THE BILL DATE, SERVICE WEBSITE AT WILL BE TERMINATED. www.cumberlandmc 3ov Rates available at WE >SITE View Cumberland's Annual Water Quality Report online in Adobe PDF form at: httnJAlnyurl.com/cpshwod Please call 301-759-6604 If you would like a paper copy of th - Annual Water Quality Report mailed to your home. After Due Date 3,065.55 Discover, 6 Debit at City Hall JOIN WWW.NE7CTDOOR.COM WHEN PAYING BY MAIL - ENCLOSE SECTION BELOW TO ENSURE PROPER CREDIT --- - ---- -- - - -.-----------................. Account # / Customer Due Date -- ......---........ _ ._ _ ._-_ ........ _ __ ..... .. Amount Due After Due Date ...... 690794002 16487 6/16/16 3,005.44 3,065.55 0 0` - O O Service Address V ®.o r 13300 ALIGHAN RD p PAYING BY CHECK OR CREDIT CARD? N WWW. CI. CUMBffiiLAM. MD. US PLEASE COMPLETE. THE BACK OF THIS STUB 2% INT/MONTH 301-759-64092 Malting Address v LOVES TRAVEL STOPS 6 537 Ir r P o BOXY?ao TY DEPT 690794002000016487061616003005449 �: ~ PARA RIDOS, NJ 07656 CTRL ID = US16-0001VZT5 ILI z 0 T 0000 0 Z0xp U D � m a to m S - V��I�°��IDiII�IJ� _ C _ V O mN N -4 b _ OX -1 0' M z �� a �rn rrn1 a o� rn m x r Zrn _. zo� w m y � o 4 NLn N c a n C 3 c b b z03 rn R1 m � x m of7NA c m . 39 N TOWN OF KIRKWOOD WATER & SEWER PO BOX 335 KIRKWOOD, NY 13795 ACCOUNT NO. BIWNG OAT-r- AT"c983-0 983-0 08/31/15 SERVICE LOCATION COLESVILLE ROAD CURRENT READING CURRENT READING DATE 1090590 08/11/15 PREVIOUS READING PREVIOUS READING DATE 937558 04/13/15 CURRENT USAGE PREVIOUS BALANCE 153032 0.00 CURRENT WATER CHARGE CURRENT SEWER CHARGE 1176.02 8799.34 FIRE SPRINKLER L AMUMT DUE 9975.36 9975.36 D AFTER ff:0111s • • 10972..8 0 PRESORT PLEASE RETURN FIRST CLASS MAIL U.S. POSTAGE PAID THIS STUB WITH PAYMENT PERMIT No. 2 KIRKWOOD, NY 13795 MAKE CHECKS PAYABLE "0: TOWN OF KIRKWOOD WATER & : EWER 983-0 COLESVILLE ROAD 10/01/15 1 10972.89 LOVE'S TRAVEL STOPS P.O. BOX 26210 OKLAHOMA CITY, OK 73126-0210 r 1 JJl1J�llJll�iJ� Jllj Ji Jllllltllll)III#pIIliI,]Il 1I1IIIII1dilllll TOWN OF LEE 286 NE COUNTY ROAD 255 LEE, FL 32059 SERVICE TO: 3204 SE CR 255 PREVIOUS READING PRESENT READING CONSUMPTION 16054 16288 234000 PREY READ DATE PRESENT READ DATE PREVIOUS BALANCE 01/15/2015 02/17/2015 0.00 SERVICE DESCRIPTION CURRENT AMT W SEW TX 587.46 2208.57 195.72 ACCOUNT NO. DUE DATE PAY BY DUE DATE 920359 03/03115 2991.75 SEE BACs( FOR IMPORTANT INFORMATION RETURN THIS STUB WITH PAYMENT LOVE'S 'TRAVEL STC PS & PO BOX 26210 OKLAHOMA CITY, OK 74135 - ACCOUNT NUMBER 920�� DUE DATE 0303/0 BILL DAT.—, 02!17/2014 PAY BY DUE )ATE 2991.74 i TOWN OF LEE ; PLEASE MAKE CHECKS PAYAE .E TO 268 NE COUNTY ROAD 255 i TOWN OF LEE LEE, FL 32059 i i FOR QUESTIONS CONCERNING THIS BILL CALL i FAILURE TO RECEIVE BILL DOE1 NOT (8W 971-5687 r WANE PAST DUE PENALT ' HOURS: 6:00 AM - SAO PM MONDAY - FRIDAY r i Payment must be received ; , Mall slots available. r Our Office on or before the due date or a 10% late char� e NOTICE It not paid by the 8th, water service w ii be i will be assessed. disconnected and the total amount due plus a $15.00 service r charge w it be required for reconnection. RATE CODES STOP LEAKSI A - Arrears COF - Cail-Out Fee CON - Connection Fee/ Meter D - Deposit I - Impact Fees P - Penalty 11 your water bill seems high, check RET - Returned Check WW - Waste Water I immediately for leaks In your sy 3tem. IRR - Irrigation T/0 - Tum on/off fee ; A leaking toilet, dripping fauc> or Tx - Utility Tax W - Water other unsuspected leak may kx, the cause of a high bill. D TOWN OF LEE 286 NE COUNTY ROAD 255 LEE, FL 32059 SERVICE TO: 3204 SE CR 255 PREVIOUS READING PRESENT READING CONSUMPTION 13185 13486 301000 PREY READ DATE PRESENT READ DATE PREVIOUS BALANCE 02/18/2014 03/17/2014 0.00 SERVICE DESCRIPTION CURRENT AMT W SEW TX ACCOUNT NO, DUE DATE 734.19 2837.03 249.98 PAY BY DUE DATE 920359 04/03/14 3821.20 SEE BACK FOR IMPORTANT INFORMATION RETURN THIS STUB WITH PAYMENT LOVE'S TRAVEL STO.''S & PO BOX 26210 OKLAHOMA CITY, OK '4135 - ACCOUNT NUMBER BILL DATE 920359 103/17/2014 DUE DATE PAY BY DUE D:.TE 04/03/2014 3 TOWN OF LEE 288 NE COUNTY ROAD 255 LEE, FL 32059 FOR QUESTIONS CONCERNING THIS BILL CALL MW 971-Sw HOURS: 8:00 AM • &00 PM MONDAY - FRIDAY Mail slob available. NOTICE H not paid by the 8th, water service will be dlsconnectsd and the total amount due plus a $15.00 service charge will be required for reconnection. RATE CODES A - Arrears COF - Cafi-Out Fee CON - Connection Feet Meter D - Deposit I - Impact Fees P - Penalty RET - Returned Check WW - Waste Wader IRA - Irrigation T/O - Tuns on/off fee TX - Utility Tax W - Water PLEASE MAKE CHECKS PAYABI TO TOWN OF LEE FAILURE TO RECEIVE BILL DOE! NOT WANE PAST DUE PENALTY Payment must be received it our office on or before the due date or a 10% late charg.. will be assessed. STOP LEAKS1 If your water bill seems high, ch -mak immediately for leaks In your sys am A leaking toilet, dripping fauces or other unsuspected leak may be to cause of a high bill. TOWN OF LEE 286 NE COUNTY ROAD 255 LEE, FL 32059 SERVICE TO: 3204 SE CR 255 ACCOUNT NUMBER PREVIOUS READING PRESENT READING CONSUMPTION 13185 13486 301000 PREY READ DATE PRESENT READ DATE PREVIOUS BALANCE 02/18/2014 1 03/17/2014 0.00 SERVICE DESCRIPTION CURRENT AMT W SEW TX 734.19 2837.03 249.98 ACCOUNT NO, DUE DATE PAY BY DUE DATE 920359 04/03/14 3821.20 SEE BACK FOR IMPORTANT INFORMATION RETURN THIS STUB WITH PAYMENT LOVE'S TRAVEL STOPS & PO BOX 26210 OKLAHOMA CITY, OK 74135 - ACCOUNT NUMBER BILL DATE 92035903/17/2014 DUE DATE PAY BY DUE DATE 04/03/2014 1 382 TOWN OF LEE 288 NE COUNTY ROAD 255 LEE, FL 32059 FOR QUESTIONS CONCERNING THIS BILL CALL f65o}871.5867 HOURS. 8roo AM - S.�o PM MONDAY - FRIDAY Mail slots available. NOTICE: N not paid by the 8th, water service will be di.sconnected and the total amount due plus a $15.00 service charge va be required for reconnection. RATE CODES A - ARS COF - W -Out Fee CON - Connection Fee/ Meter D - Deposit I - Impact Fees P - Penalty RET - Returned Check WW - Waste Water IRR - Irrigation T/O - Tum ontoff fee TX - Utility Tax W - Water PLEASE MAKE CHECKS PAYABI TO TOWN OF LEE FAILURE TO RECEIVE BILL DOE:' NOT WAIVE PAST DUE PENALTY Payment must be received it our office on or before the due date or a 10% late charg will be assessed. STOP Lt`AKS1 If your water bill seems high, ch: ck immediately for leaks in your sys'sm. A leaking toilet, dripping faucet or other unsuspected leak may be 'be cause of a high bill. M,' FOR WATER METERS (Requirin a vault INFORMATION REQUIRED: I. Review comments by State or City Fire Marshall provided. (To be attached to this form). II. Specific Data: 1. Fire Protection Consultant/Company: Contact Name Phone Number 10aW- �alo3 2. Nature of business requiring a meter larger than City's standard 4": F�tln l�RAc� icv� 3. Size of meter requested: 4" _ 6" _other 4. How many Private Fire Hydrants on the system? Z. 5. Maximum fire flow required )'%Om gpin h. Minimum flow requiredGO(-)�gpm 7. NFPA 13 occupancy classification category( Ve.g. Light, OH, EH I, etc.) 8. Size of future expansion possible s.f. (Relative to vault size) 9. Prior comparable installation(s): Business Name Location Size meter installed 10. Name of Project: OVA �� ��-u��C S cP -- III. Owner Acknowledgement: It is understood that underground piping shall be flushed in accordance with NFPA before the vault is installed. The Utilities Department Inspector shall observe the flushing ofsl'ie lines and tune the length of the flush. This field verification is necessary for the C Itilities enartment to bill the Owner for water used. Printed Name c D t Note: "I'llis completed form shall be provided to the Water and Wastewater Department prior to site pian approval. H:lwatersewerlKimlStandard Detail