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WASHINGTON
3S W. WASHINGTON STREET
P.O. BOX 571
COUNTY SANITARY DISTRICT PERMIT NO. 71
HAGERSTOWN, MARYLAND 21741-0571 (301) 791-3083 1 3084 DATE / / 1 1 L85
PERMIT TO CONNECT TO PUBLIC SEWE RAG E/W.ATER SYSTEM
SUBDISTRICT No. 1;
Maugansvi l i.,�1 Ur'C laf'u Hi l is
Permission is hereby given to: U U Lg 1 3I i+11 1 1 S
For Property Located at: 2314 T ad t an Cottage R o a d
1'i i I I MAD
Owned by: Lt��i1411 �`' I� c Address:
Type of Connection: To Service Connection
Type of Service: Residential
Commercial
Meter Size
( ) Units
Connection Fee �620.OU
_ To Main Liner
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.
Water Account No. 0-15-8535-2
Secretary -Treasurer Q p d UQ)r--
Building Permit No.
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
&Z/'L
Final Inspection Made BY: Date
lumbing 119pector
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
Date
Field Office City of Hag. 1
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WASHINGTON COUNTY SAN) ARY DISTRICT SANITARY SEWCR LATE
WASHINGTON COUNTY, MO. CONSTRUCTION REC(mr)
Project: __Qnov lle/Orchard Hills Sanitary Seuarace Collection Svl&gg
1%5c, JL -
Street
Street (or location): 64I 72.4( 3i4 ,11014A! j oOCM F-
Contractor: Lisbon Contractors, Inc. 0"las i ice.
MH �7-1 TO MH .5zz i
Data Installed_-zoJune- 64- Wye Ste. On min o+97.6&f
V X±o X �j••
otal
MAiN
t I
Depth of Cleanout gv, :. (flow Line
Cleanout f(, - (o From�A-tA)N
Layed Q 2
• >9ssig6j;- Basement Service
Mi#�?,
U
�ZZ
Amounts ps Mining to work completed this period, reviewed and approved.
By
Insp c er Contractors Rep.
1
PK
Washington County Sanitary District
SEWER SERVICE LOCATION
Subdistrict No. SD#15
1 g,) 6,:)— Contract No. SD15- 3-S
Property Address: 2 4 Indian Cottage Road
ISH 521 to MH 522 _ DWG. #601-317
Place an 'X' in the sketch below to indicate where the property
owner wants the service connection (lateral) to enter the
property. Place a wooden stake in the ground at that location.
i
a
o
724 i( W o {
(2314) 1 rn I C7 C\j
N a ,
p
R / Cn co U')I U
w
515 - 521 Q o
8" I —
— SAN. 3 0 w
Is w M s :Q0 Z w
I N 5015 ` 52 � U)
2
The undersigned agrees that the Sanitary District may
excavate an additional five (5) feet inside the property
line so as to facilitate, and make less expensive, the owner's
connection to the lateral and to prevent damage to the cleanout
which will be installed by the District near the property
line.
Date:
wner
Attest:�z J 3
WasV. Co. Sanitary District
(Form WCSC-1)
Replaces Form WCSC-56
wner