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PROJECT NAME: FQUNTAINHr:,9 S1=WCR PROJECT NO: SCP 060 -12-14P
PROPERTY ADDRESS: 13 i 1 y AANNS i LV N Ii IA AVE- DRAWING NO:
MAIN LOCATION: STREET/EASEMENT DATE INSTALLED: 2 -
PROPERTY
PROPERTY OWNER NAME: T 14 FE -0 00 RE S H A NIK MH &0--307 TO MH 6013006
PROPERTY OWNER ADDRESS: I � % 2,7yA, A VE MAIN STATION: 1,f 26"'T
H AG F RSTo W rV M ci Z )-7 yQ SINGLE: —t/— DOUBLE:
CONTRACTOR: CONNECTION ® MH:
SIZE & TYPE
SIZE & TYPE
INVERT ®
DEPTH
DROP
TEE/WYE
SERVICE PIPE
MAIN (A)
C/O (B)
DEPTH (C)
D
E
F
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N A
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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).
B C
B
q
IA A
4D E.. F D E D E
SHOW LATERAL LOCATION, STATION, UTILITY CROSSINGS AND DIMENSION ALL PERTINENT ITEMS
FLOW LEFT
J 26,5
DOWNSTREAM
MH # &,o '3o7
RIGHT
-Ok-- 250
LIST (QUANTITIES FOR PAY ITEMS HERE: -5F-15 WORK O R 0 EQ k ZQ Z. 4 4
BY: SH 1)N17 -= f=. F0 (-NCI{
WASHINGTON COUNTY INSPECTOR
mIK12-- MARKER
DIVISION OF PUBLIC WORKS
WASHINGTON COU/4n; MARIZAND
WATER AND SEWER
DEPARTMENT
UPSTREAM
MH # &o -30 g
Tim TH-om ()so PJ
CONTRACTOR'S REPRESENTATIVE
Co. NAME: THOMPSo N CoNsTRucnoI0
GRAVITY SEWER SERVICE
CONNECTION SHEET
MARCH 1996 1 S-13.2
A. 10 .r.
REQUEST TO ALTER SANITARY SEWER
SERVICE LATERAL
TO: Washington County Water and Sewer Department
16232 Elliott Parkway
Williamsport, MD 21795
We hereby request permission to install the house lateral described below, at
Street Nameo I
Lot Number:
Manhole:
Station:
SD -(00 -30 7 To Manhole:
S'b-('�o -309
Left; / Right
( ) From % to Grade
( v/) From standard lateral to drop at cleanout
( ) Depth at cleanout
This request is made on this date��( Q z,
BY: ILI
REPRESENTING:
Representative
APPROVED BY: Washington County Water and Sewer Department
WCWSD Representative
aN coG WASHINGTON CO--�
3 WATER & SEWER DEP &YE
16232 Elliott Parkway FEB 1 2 2002
' Williamsport, MD 21795
(301) 791-3083 Va' M 03
PERMITS AND ffnb-I'
Permit to Connect to Public Water/Sewer System INSPECTIONS
Type of Permit COM SEWER
Subdistrict Name FOUNTAINHEAD
Mainline Contract No.
Building Permit No. P2001-2532
Permission is hereby given to:
Permit No. SCP 060-1216
Issue Date 02/07/02
Void Date 02/07/03
Subdistrict No. 060
Property Owner: THEODORE SHANK
of address: 17827 VIRGINIA AVENUE
HAGERSTOWN MD 21740
For property located at: 13114 PENNSYLVANIA AVENUE Street Address
Lot No. Subdiv. BLOCKBUSTER VIDEO & OFF I CIPhase Sec.
Owner's Agent: THEODORE SHANK
Agent's Address: 17827 VIRGINIA AVENUE HAGERSTOWN MD 21740
Previous Owner:
Fees Paid in Full? YES Lateral with Mainline? YES
Date Fees Paid Residential EDU's
Fee $ Commercial EDU's
WCWSD Alloc./Conn. Fee $ Gal/Day Allocation
WCWSD/Other Fee $ Building Number
City of Hagerstown Fee $ $1, 200 Misc. Number
Total Fee $ $3,300
Remarks A FEE DIFFERENTIAL WILL BE CHARGED TO REFLECT ALLOCATION FEE
INCREASE IF PROPERTY IS NOT CONNECTED BY THE PERMIT VOID DATE.
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, HE PROP RTY OWNER.
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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
100 W. Washington Street, Room 304
Hagerstown, MD 21740-4727
Phone: (301) 791-3070
Inspection Date: // / �� Plumbing Inspector: