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PROJECT NAME: -1 -1r -e4 1-�.rllS
PROPERTY ADDRESS: Lars. 1,3 � A /7�� j / �� PROJECT N
7 � �J� f'DRAWING NO:- : �cF l.Y
MAIN LOCATION: EET ASEMENTDATE INSTALLED: 3-IF-63—
PROPERTY OWNER NAME: MFI
PROPERTY OWNER ADDRESS: TO MH / d �l
MAIN STATION:
CONTRACTOR: h/. xl"-r"l
CONNECTION ®MH:/,�y9�a�d'
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ALL NtK HENT ITEMS
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LIST QUANTITIES FOR PAY ITEMS HERE:
BY:
WASHINGTON COUNTY INSPECTOR
DIVISION OF PUBLIC WORKS
c� WASHINGTON COUNTY, MARYLANO
WATER AND SEWER
DEPARTMENT
LEFT
RIGHT
UPSTREAM
MH # 1
CONTRACTOR'S REPRESENTATIVE
CO. NAME:
DOUBLE GRAVITY SEWER LATERAL
CONNECTION SHEET
MAY 2001
S -13.2A
Washington County, Maryland
A Department of Water Quality
`f 16232 Elliott Parkway
Williamsport, MD 21795 /1Q13)09
* " 240.313.2600 rmQa0
PUBLIC WATER/SEWER SYSTEM CONNECTION PERMIT
Type of permit: RES
Type of service: SEWER
Service Area: Mau gansvi I le/Orchard Hills
Building Permit No.:
WASHCO account No.: 0
Service Area No.: 150
Permission is hereby given to:
Property Owner: TOM & THEODORE SHANK
Applicant: TOM & THEODORE SHANK
Street: 17827 VIRGINIA AVENUE
City: HAGERSTOWN
State: MD
Zipcode: 21740 g a G
For property located at:
Street: -z-�� U
City: HAGERSTOWN �Vf�,C.
State: MD w
Zipcode:21740
Is the property in a subdivison? YES
Subdivision name: FREEDOM HILLS
Subdivison lot no.:
Subdivision phase: 14
Subdivison section:
Additional remarks:
Will DWQ need to connect the lateral
to the mainline?
Permit No.: 3297
Issue Date: 09/15/2004
*Void Date: 09/15/2005
Fees paid in full? YES
Date fees paid: 09/13/2004
Type of EDU: RES
Number of EDU's: 1
Gallons per day allocation: 200
DWQ connection fee: $1,800.00
Misc. connection fees: $300.00
City fees paid to (city):
City fees (amount): $1,800.00
Total fees charged: $3,900.00
Water & Sewer Department notes:
*Connection related comments:
This permit is good for one 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.
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 permits, etc.
ALL OTHER PERMITS, STATE AND LOCAL, MUST BE OBTAINED BY THE PROPERTY OWNER AND ALL RESPONSIBILITY CONNECTED THERE
WITH REMAINS WITH THE PROPERTY OWNER.
Signed:/3 /'3 Date: 09/15/2004
INSPECTION: At least 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: