HomeMy WebLinkAboutNoLat_13321CearfossPike�:djt✓w WASHINGTON COUNTY
3 WATER & SEWER DEPARTMENT
16232 Elliott Parkway
Williamsport, MD 21795
"Rr��No (301) 791-3083 /Mlatr
Permit to Connect to Public Water/Sewer System
Type of Permit
Subdistrict Name
Mainline Contract No.
Building Permit No.
Permission is hereby given to:
Property Owner:
of address:
For property located at:
Lot No. Subdiv.
Owner's Agent: _
Agent's Address:
Previous Owner:
Fees Paid in Full?
Date Fees Paid
Fee $
WCWSD Alloc./Conn. Fee $
WCWSD/Other Fee $
City of Hagerstown Fee $
Permit No.
Issue Date
Void Date
Subdistrict No.
4
Street Address
Phase Sec.
Lateral with Mainline?
Residential EDU's
Commercial EDU's 4
Gal/Day Allocation 800
Building Number
Misc. Number
Total Fee $
�,-
Remarks .:.: ; , __ - AST
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.
Signed ;f Date: 4
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: } -0 J Plumbing Inspector: