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WASHINGTON COUNTY SANITARY DISTRICT PERMIT NO.
33 W. WASHINGTON STREET HAGERSTOWN, MARYLAND 21741-0571 (301) 791-3083/3084 DATE
P.O. BOX 571
SUBDISTRICT
PERMIT TO CONNECT TO PUBLIC SEWERAGE/WATER SYSTEM
Permission is hereby given to: 13101 I 1,6Ioq I la
For Property Located at:
Owned by
Type of Connection: To Service Connection
Type of Service: Residential
Commercial
Meter Size
Address:
Connection Fee
To Main Line:
Units Other
Industrial
Date Paid 9I ) J� / S(,
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.
THL r ritc l f ct:, ult HIS kEPkE-�ENiA IVE SHALL CONTACT IHE CI !Y OF HA6ERSTUWN WA1Ek
POLLUTION CONTROL DEPARTMENT (790-3200) Ext. 166 TO SCHEDULE THE SEWER CONNECTION
INSTALLATION. p; f /�1, ., FI
Secretary -Treasurer
Building Permit No. O • ,.
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
Plumbing Inspector
/y 6/_ 00'
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
N
Field Office
Date