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WASHINGTON COUNTY SANITARY DISTRICT Elliott Parkway 70/81 Industrial Park Williamsport, Md. 21795 Telephone 301-223-9416 Permit to Connect to Public Water/Sewer System Type of Permit RES SEWER, Permit No. 5trp 150__ 1 I FI -- Subdistrict Name Issue Date Mainline Contract No. r '" Void Date Building Permit No. �,� _---Subdistrict No. Permission is hereby given to: Property Owner: ' OHN � ,,r..,.. ; IAi E', OL!"'I' of address: ' ` Street Address For property located at: Et.T,)TE• Phase-Sec.- hase Sec.Owner's Lot No. Subdiv. ; iQRTHBEQC;t � Owner'sAgent: 7,2 O r V t-0 INC, L" ITERSElif<6 LIL Agent's Address: Previous Owner: Fees Paid in Full? Lateral with Mainline? Date Fees Paid Residential EDU'S WCSD Dist./Coll. System Fee $ Commercial EDU'S WCSD Ready to Serve Fee $ G O© Gal/Day Allocation WCSD Fee $ '2GG Building Number City of `'M '` Y' ^"'' Fee $ > OC, Utility Number Total Fee $ _ ALO 00 Remarks 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 WCSD 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 REMAINS WITH THE PROPERTY OWNER. Signed: Date: INSPECTION: At least 48 hours notice prior to requested date is required. ON SITE INSPECTION will be made by: Washington County Plumbing Board 33 W. Washington Street /� Hagerstown, Md. 21740 Phone: 791 Inspection Date: "G� `B Plumbing Inspector OFF SITE INSPECTION (in Public Rights of Way and Easements) by WCSD Inspection Date: Inspection Date: WCSD Inspector (Lateral) — WCSD Inspector (Connection) Distribution: Permittee City of Hagerstown — WCSD Construction WCSD O&M Permits Office Plumbing Board City of Williamsport _WCSD File Plumbing Inspe t� 1— -- . APR 2 6 19M I ; WASHINGTON COUNTY SANITARY DISTRICT WASHINGTON COUNTY, MD Project: Aio h ?3toaK E.sTaTcS Co/lecTo;, Sys/"e-..., L-ISo-a G6 Street (or location): ORQYiC 407-5 s/¢s2 / Contractor: %a,rsn_ryd,1E 6a1,Ts-�cri�s /-3�/'�` 1 Date Installed I/— ;z 3 - 47, SANITARY SEWER LATERA CONSTRUCTION REPORT M H TO MH i>s--' Wye Sta. On Main a7-- WYE T WYE SIZE- TYPE DEPTH TYPE EXCAVATION TYPE PIPE C. 0. C.O. LATERAL LENGTH LAYING LENGTH C'"> Horiz. = Total y ST 'D. SO'r- z 6 d-'ksJ NOTES Slope + Horiz. = Tota DROP 4 3 L F 13e-'; A, 2Dc!5 Q` DO wb/e Wye F;7flns I Depth of Cleanout at Flow Line Cleanout /3 From rh-;-, 0-ve e Loyed at 2/r, No Basement Service 0-4- 01 11'rMH # /iso MH# /is-& Amounts //pertaining o work completed this period, reviewed and approved. e Y W 7 WCSD INSPECTOR CONTRACTORS REPRESENTATIVE WASHINGTON COUNTY SANITARY DISTRICT AUGUST 13, 1984 S' Z R ,,UEST TO ALTER SANITARY SE�.�R SERVICE LATERAL TO: Washington County Sanitary District Rt. 3 -Box 1075 Elliott Paikway Williamsport, MD. 21795 We hereby request permission to install the house lateral described below, at /yorTh BrooK sTarzs Street Name: Lot Number: SJ S� Manhole /%6-57 to Manhole //576 Station / f o i i?% Left / Right ( ) From % to Grade ( ✓) From Standard lateral to drop -at cleanout_ ( ) Depth at cleanout This request is made on this date /</ -• -�' 3 - a ;�' BY: REPRESENTING: J-0 j3, P4 ver C-0, CGliw1 /� • 'Ml CX Representative APPROVED BY: Washington County Sanitary District W.C.S.D. Representative