HomeMy WebLinkAboutNoLat_14700CiticorpDriveVIYASHINGTON COUNTY SANITARY DISTRICT
33 W. WASHINGTON STREET PERMIT NO.
HAGERSTOWN, MARYLAND 21140 -----
3
PERMIT TO CONNECT TO PUBLIC SEWERAGE/WATER SYSTEM
Permission is hereby given to:
For Property Located at:
Owned by:
— Address:
Type of Connection: To Service Connection
Type of Service: Residential
Commercial
Meter Size
Connection Fee
0�) 791-13C6
A��I
D „_
�o`"��
SUBDISTRICT
To Main Line:
Units Other
Industrial
Date Paid
To connect to a public sewerage/water system (with proper abandonment of previous private system). The installation
of the connection and the abandonment of the previous private system shall conform with the provisions of the
Laws of the State of Maryland and Washington County Sanitary District Specifications.
This permit does not supersede any local ordinance that is in effect with regards to road cutting, etc.
ALL OTHER PERMITS, STATE AND LOCAL, MUST BE OBTAINED BY THE PROPERTY OWNER AND ALL RESPON-
SIBILITY CONNECTED THEREWITH REMAINS WITH THE PROPERTY OWNER.
Building Permit No.
Secretary -Treasurer
INSPECTION: At least 48 hours notice prior to requested date of inspection is required.
ON SITE INSPECTION will be made by
Washington County Plumbing Board
33 W. Washington Street
Hagerstown, Maryland 21740
Telephone: 791-3146
Permit Fee
Final Inspection Made BY: '
Date I,-
Plumbing--
I pector
—�-
OFF-SITE INSPECTION (in Public Rights -of -Way and Easements) and certain
ON-SITE INSPECTION in accordance with applicable approved construction drawings will be made by:
Washington County Sanitary District
33 W. Washington Street
Hagerstown, Maryland 21740
Final Inspection Made By: _
Date
DISTRIBUTION: Permittee Plumbing Boa
Field Offic
WIWiSHiNGTON COUNTY PLUMBING BOARD FOR OFFICE USE ONLY
COUNTY OFFICE BUILDING 33 W. WASHINGTON ST. HAGERSTOWN, MD. 21740 PHONE 791-3070 Permit No._
APPLICATION FOR PLUMBING PERMIT (Plumbi�ng)
Date Recd. J -�/ ' J - _Y&_
Date �Q 19 �CQ� ojo /Vc [_k' {=
Permit No. Cash Check
� (Building)
I hereby apply for permission to do the work, as listed, on the property described as follows, for which 1 tender herewith
the required fee. Permit expires 1 year after date of issue.
Owners Name E ill C �I �>'oLc n - CL%Q� �j, f r„t �b 7 c,_1 Phone No
1 �
Location of Property'y- A `
(House No. & Street: also nearest intersecting road or street)
Town or Vicinity
Sub division Lot Block
Section
Is property located within city limits of municipality? (Yes) (No) If yes, name
the municipality
A. TYPE OF IMPROVEMENT B. TYPE OF HEATING FUEL C. TYPE SEWERAGE DISPOSAL
D. TYPE OF WATER SUPPLY
I. ❑ NEW BUILDING CONSTRUCTION 1. ❑ GAS (HOT AIR OR HOT WATER) 1. ❑ PUBLIC SEWER 1.6PUBLIC SYSTEM
2. ❑ ADDITION 2. ❑ OIL (HOT AIR OR HOT WATER) 2. ❑ PRIVATE SYSTEM 2. ❑ PRIVATE SYSTEM
3. ❑ ALTERATION 3. ❑ COAL (HOT AIR OR HOT WATER) ❑ EXISTS E] PROPOSED
❑ EXISTSPROPOSED
4. ❑ REPAIR 4. ❑ ELECTRICITY ( SEE SPECIAL FOOTNOTE)
I have been authorized by the owner to do the work
herein described, and in the execution thereof, I agree to
abide by the regulations of the Washington County Plumb-
ing Board.
OWNER
(address, if differ nrom above)
Master Plumber
MD. License No.
Washington County Plumbing Board.
License No. C; — / /
SPECIAL FOOTNOTE: If plumbing wort< involves
tapping a public water or
sewer system or both, a receipt for payment of applicable
fees and/or charges from the proper municipality or the
Washington County Sanitary Commission MUST BE PRE-
SENTED with plumbing application.
INSPECTOR'S APPROVAL
Connection to
c Sewer
X
Date _2;*�
Connection to
c Water)
Date
Underground
) Date
Rough -In ( ) Date
Final Approval All Plumbing (X Date
HERE" PROPOSED PLUMBING WORK CHARGES
o;� Building Water Service
Building Sewer Service
INSPECTION REQUEST
CALLER !�CltiiIYIG L Ltci f,
PHONE l; ;
LOCATION
PERMIT NUMBER
TYPE INSPECTION GUC�ZCLt�r/(�� ()�l�
TIME TAKEN DATE .4te72t° /4 -u s_
DATE REQUESTED 10e . maz l_ .2—Y
TAKEN BY kbi)
INSPECTOR
DATE INSPECTED DISTRICT
_
P 1 umb .-Elec.
Water Conditioner
Garbage Disposal
Ice Maker
TOTAL
�J f�/' Ak t �I
! 'k
Make Checks Payable To: BOARD OF COUNTY COMMISSIONERS
Health Dept. No.
WASHINGTON COUNTY SANITARY_ DISTRICT
33 W. WASHINGTON STREET HAGERSTOWN, MARYLAND 21741-0571
P.O. BOX 571
PERMIT TO CONNECT TO PUBLIC SEWERAGE/WATER SYSTEM
(301) 791-3083/3084
7 v
PERMIT NO.
DATE
SUBDISTRICT j �) . I o
Ma,.4_/Orchard
Permission is hereby given to: Paid ev `+nwn - Washington Co, industrial H i l 1 s
Foun ations, inc.
For Property Located at: ttOuLe e,. hdgerstown MD 21740 (Clopper 'Tenant House)
Owned by: Hagerstown - Washington CAddress:980 {`forth Potomac Street, Hagerstown, AD 4174U
Austrial Foundations, inc.
Type of Connection: To Service Connection _ X To Main Line:
Type of Service: Residential
Commercial
) Units Other
Industrial
Meter Size _ Connection Fee �07GU (JU Date Paid 0
To connect to a public sewerage/water system (with proper abandonment of previous private system). The installation
of the connection and the abandonment of the previous private system shall conform with the provisions of the
Laws of the State of Maryland and Washington County Sanitary District Specifications.
This permit does not supersede any local ordinance that is in effect with regards to road cutting, etc.
ALL OTHER PERMITS, STATE AND LOCAL, MUST BE OBTAINED BY THE PROPERTY OWNER AND ALL RESPON-
SIBILITY CONNECTED THEREWITH REMAINS WITH THE PROPERTY OWNER.
Secretary -Treasurer
Building Permit No.
INSPECTION: At least 48 hours notice prior to requested date of inspection is required.
ON SITE INSPECTION will be made by
Permit Fee
Final Inspection Made BY
Washington County Plumbing Board
33 W. Washington Street
Hagerstown, Maryland 21740
Telephone: 791-3146
Plumbing I pector
Date O
OFF-SITE INSPECTION (in Public Rights -of -Way and Easements) and certain
ON-SITE INSPECTION in accordance with applicable approved construction drawings will be made by:
Washington County Sanitary District
33 W. Washington Street-P.O. Box 571
Hagerstown, Maryland 21741-0571
Final Inspection Made By:
DISTRIBUTION: Permittee Plumbing Board 3
Date
Field Office City of Hagerstown 1