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PROPERTY ADDRESS: L6 -(A 860 DRAWING N0: SA"-:71ET cl
MAIN LOCATION: STREET/EAtENT DATE INSTALLED:'
PROPERTY OWNER NAME: MH RLS-- TO MH t.4.3Z
PROPERTY OWNER ADDRESS: MAIN STATION:
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SIZE & TYPE
SIZE & TYPE
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INDICATE TYPE OF LATERAL BY CROSSING OUT OTHERS. FOR CONNEC.-;O , TO MANHOLE, CHECK AB -'-)VE,
AND LIST INVERT DIN'c iOt•J 'B' AND DROP DIMENSION .C' (IF APPLICA-EL.E?
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LIST QUANTITIES FOR PAY ITEMS HERE:
WASHINGTON C UhlT'I' INSPE.::TOR
DMS10N OF PUBLIC WORKS
c =q, WASHINGTON COUNTY, MARYLAND
WATER AND SEWER
DEPARWENT
:T?., -T
jOR'S REPRESENTATIVE
CO. NAME:
GRAVITY SEWER SERVICE
CONNECTION SHEET
JANUARY 1999 1 S-13.2