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WASHINGTON COUNTY
.WATER & SEWER DEPARTMENT
16232 Elliott Parkway
Williamsport, MD 21795 � 10/3101 nnCL,,r
(301) 791-3083
Permit to Connect to Public Water/Sewer System
Type of Permit RES SEWER
150- 1 `} T t
Subdistrict Name
Permit No. SCP
Mainline Contract No.
Issue Date
Building Permit No. _
Void Date
Subdistrict No. 010
Permission is hereby given to:
Property Owner: DAVID SHAOOL
of address:
For property located at:
Lot No. 37 Subdiv. FOU
Street Address
Phase Sec.
Owner's Agent: DAVID SHAOOL
Agent's Address: 110PLUMW00
RCL
Previous Owner:
Fees Paid in Full? YES
Date Fees Paid Lateral with Mainline? YES
Residential EDU's
Fee $ Commercial EDU's
WCWSD Alloc./Conn. Fee $ , Gal/Day Allocation �—
WCWSD/Other Fee $ Building Number /
City of Hagerstown Fee $ Misc. Number
Remarks Total Fee $
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 excavations, plumbing
STATE AND LOCAL, MUST BE OBTAINED BY THE PROPERTY OWNER AND ALL RESPONSIBILITY CONNECTEDOTHER THEREWITH RE
MAINS WITH HE PR P RTY OWNER.
Sig" Date: l J
INSPECTION: At least 48 hours notice prior to requested date is required.
ON SITE INSPECTION will be made by: Washington County Plumbing Board
100 W. Washington Street, Room 304
Hagerstown, MD 21740-4727
C� Phone: (301) 791-3070
Inspection Date: Plumbing Inspector:
PROJECT NAME:
PROPERTY ADDRESS:1=4 -36 an 714 37 1 EJECT NO; ....._ ISO- 616
MAIN LOCA TION: STREET ASEMEN D R A W1 N G NO:
PROPERTY OWNER NAME: DATE INS ED:
PROPERTY OWNER ADDRESS: MH AE
MH L-5 12:]Q3:
MAIN STATION: t+39,Scar
-
CONTRACTOR: C"Mie-
CONNECTION 0 MH:
-1111 LIMILNOIUN ALL PER
FLOW
LEFT
DOWNSTREAM
MH # 1$;9- 7c?,q
LIST QUANTITIES FOR PAY ITEMS HERE:
E'er
WASHINGTON COUNTY INSPECTOR
DIOSION OF PUBLIC WORKS
WASPINGTON COUNTY, "ApytMo
WATER AND SEWER
DEPARTMENT
A
is 14
tnaj ol
RIGHT
Rm
T ITEMS
UPSTREAM
MH # Lg!--093
CONTRACTOR'S REPRESENTATIVE
CO. NAME:
DOUBLE GRAVITY SEWER LATERAL
CONNECTION SHEET
MAY 2001
I S --13.2A