HomeMy WebLinkAboutLat_19728MarigoldDrive0N c�G WASHINGTON COUNTY
3 WATER & SEWER DEPARTMENT
_ 4 16232 Elliott Parkway
Williamsport, MD 21795�/
r
�'"9RyLnN" (301) 791-3083 &%a310 0
Permit to Connect to Public Water/Sewer System
Type of Permit SF,4EF Permit No. SCI' 154-1441
Subdistrict Name 7 OFIssue Date
Mainline Contract No. Void Date
Building Permit No. �` -` Subdistrict No
Permission is hereby given to:
Property Owner: 11.t1 R • OLIVER CO.
of address: !9733 LEITERSBURG it
li
For property located at: Street Address
Lot No. 65 Subdiv. NORTHBhOU Phase Sec.
Owner's Agent: dC-IHN R. OLIVER CO .
Agent's Address: 19733S
BURG
Previous Owner:
Fees Paid in Full? YES Lateral with Mainline?
.'ES
natn FAA paid % Residential EDU's
WCWSD Alloc./Conn.
WCWSD/Other
City of Hagerstown_
RemarO -,17
'
S,
Fee
Fee
Fee
Fee
Total Fee
Commercial EDU's 0
Gal/Day Allocation `
Building Number
Misc. Number
S !: 9-31-91: IN THE AROUNI4
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 THEREWITH RE-
MAINS WITH THE PROPERTY OWNER. jh
Signed: Date:JJJJ l_
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
Phone: (301) 791-3070 /
Inspection Date: Plumbing Inspector:�i
PROJECT NAME: ti/�/-�XT'�'
,�T�r'ROJECT NO:
PROPERTY ADDRESS: DRAWING NO:
MAIN LOCATION: STREET/EASEMENT ci' DATE INSTALLED:
PROPERTY OWNER NAME:
((72 i 97Lt; MH—.!L/ TO MH 1/72
PROPERTY OWNER ADDRESS:
MAIN STATION: ir0z�l L�:
SINGLE: DOUBLE:—
CONTRACTOR:ez'��'%����5 CONNECTION 9 MH:�
SIZE & TYPE SIZE & TYPE INVERT ® DEPTH DROP D E F
TEE/WYE SERVICE PIPE MAIN (A) C/0 (B) DEPTH (C)
2 C 3,5
INDICATE TYPE OF LATERAL BY CROSSING OUT OTHERS. FOR CONNECTION TO MANHOLE, CHECK ABOVE,
ANn I IST INVERT DIME51ON 'B' AND DROP DIMENSION 'C' (IF APPLICABLE).
(E\ CBAA Ap F D E D
SHOW LATERAL LOCATION, STATION, UTILITY CROSSINGS AND DIMENSION ALL PERTINENT ITEMS
FLOW �41 /LEFT
DOWNSTREAM RIGHT UPSTREAM
MH # 11l.1 MH # 117
LIST QUANTITIES FOR PAY ITEMS HERE:
BY: c►–�
WASHINGTON COUNTY INSPECTOR
DIVISION OF PUBLIC WORKS
WASH/NG7i7N CDUN7Y, UAR12AND
WATER AND SEWER
DEPARTMENT
i
CONTRACTOR'S REPRESENTATIVE
CO. NAME:
GRAVITY SEWER SERVICE
CONNECTION SHEET
MARCH 1995 I S-13.2