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DROJECT NAME: F/ZEIEbom 14ILLS fa -1 PROJECT NO: fro- 8S'
'Ri bADDRESS:. l'/liA/Q.T UJp Y DRAWING NO:
v AIN LOCATION: STREET/EASEMENT 4 -OT 3 3 DATE . INS�TAJ-LED: _ (r,? %� <,
'ROPERTY OWNER NAME:MH �5�� TO MH / �5�1
PROPERTY OWNER .ADDRESS: MAIN STA -n : _ o j (o-), 9-Y.ONTRACTOR: '5q-lrkA F1 iE iib .E/ 7',6A '121,5 F SINGLE: DOUBLE: S SINGLE:
9) MH:
Sr1UYV LA I LKAL LUUA HUN, STATION, UTILITY CROSSINGS AND DIMENSION ALL PERTINENT ITEMS
SIZE & TYPE SIZE & TYPE INVERT ® DEPTH DROP
TEE/WYE SERVICE PIPE C.O. .WYE (A) C/0 (B) DEPTH (C) D E F
g Z� Pve A� (,p ,or sbe Zb Pdc 5�5•�a 55.E aD�s� 3.a
INDICATE TYPE OF LATERAL BY CROSSING OUT OTHERS. FOR CONNECTION TO MANHOLE, CHECK ,ABOVE,
AND LIST INVERT DIMESION 'B' AND DROP DIMENSION 'C' (IF APPLICABLE).
FLOW
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DOWNSTREAM
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LIST QUANTITIES FOR PAY ITEMS HERE:
m
INGTON COUNTY INSPECTOR
DIVISION OF PUBLIC WORKS
WASHINGTON COUNTY, MARYLAND
�163'
DEPARTMENT OF
�� WATER QUALITY
LEFT
RIGHT UPSTREAM
MH # �sSR
CONTRACTOR'S REPRESENTATIVE
CO. NAME:
GRAVITY SEWER SERVICE
CONNECTION SHEET
SEPT -'EER 20-o= � C-13 i