HomeMy WebLinkAboutLat_13703PennsylvaniaAvenue""WASHINGTON COUNTY SANITARY DISTRICT
33 W. WASHINGTON STREET HAGERSTOWN, MARYLAND 21740
PERMIT TO CONNECT TO PUBLIC SEWERAGE/WATER SYSTEM
Permission is hereby given to:
For Property Located at:
Owned by:
Type of Connection: To Service Connection
Type of Service: Residential
Commercial _
Meter Size
Address:
Connection Fee
) Units
(301) 791-3UdJIJUb4
�r103
To Main Line:
—
Other
Industrial
Date Paid
PERMIT NO.
DATE
SUBDISTRICT
To connect to a public sewerage/water system (with proper abandonment of previous private system). The installation
of the connection and the abandonment of the previous private system shall conform with the provisions of the
Laws of the State of Maryland and Washington County Sanitary District Specifications.
This permit does not supersede any local ordinance that is in effect with regards to road cutting, etc.
ALL OTHER PERMITS, STATE AND LOCAL, MUST BE OBTAINED BY THE PROPERTY OWNER AND ALL RESPON-
SIBILITY CONNECTED THEREWITH REMAINS WITH THE PROPERTY OWNER.
Secretary -Treasurer
Building Permit No.
INSPECTION: At least 48 hours notice prior to requested date of inspection is required.
ON SITE INSPECTION will be made by: Washington County Plumbing Board
33 W. Washington Street
Hagerstown, Maryland 21740
Telephone: 791-3146
Permit Fee
Final Inspection Made BY:_ Date
_*�� Ar <
Plu g Inspector
OFF-SITE INSPECTION (in Public Rights -of -Way and Easements) and certain
ON-SITE INSPECTION in accordance with applicable approved construction drawings will be made by:
Washington County Sanitary District
33 W. Washington Street
Hagerstown, Maryland 21740
Final Inspection Made By: Date
DISTRIBUTION: Permittee Plumbing Board
Field Office
iANITARY SEWER LATE'':
WASHINGTON COUNTY SANITARY f TRICT-ONSTRUCTION nECnim
WASHINGTON COUNTYt MO,
Project:
Mauagnevil a orcn ro n . � - - -
Street (or location) : r7Ar � 094- PA. AvSuvr >
+Ab n ' I')Y� � • �0
Cantractor s Lia o
MH 00'
Data Installed Wye Ste. On Main, 04-00 FJ4.
TYP p C p A7ER LENGTH EN T11
......-1
qE
*Horz.• Total
oar'5•�$YF gt'd. ID,3o 9.
M. H.
pe +
NOTES:
Depth of Cleanout 5.iz-: 41Flou Line ,...._.
Cleanout 7.8a' romp Md t r i
Layed 0
Basement Service
2'�fub�Cvp �'"
Amounts pertaining to wor completed this psriodg reviewed and approved*
napec orcontractors Rep.
1 Y
Washington County Sanitary District
SEWER SERVICE LOCATION
r..
Subdistrict No. SD#15 _
3'10 3 Contract No. SD15- 3-S
Property Address: Pennsylvania Avenue
SIH 683 Terminal �INTO MN3� 18p� DWG X601-335
Place an 'X' in the sketch below to indicate where the property
owner wants the service connection (lateral) to enter the
property. Place a wooden stake in the ground at that location.
- 24' OF 36
15' W IDE PERMANENT
SEWER EASEMENT SEE
TEMF
CONS
The undersigned agrees that the Sanitary District may
excavate an additional five (5) feet inside the property
line so as to facilitate, and make less expensive, the owner's
connection to the lateral and to prevent damage to the cleanout
which will be installed by the District at or near the property
line. ,
Date:%0712`3 Owner
s
Owner
0001,
Attest: 2
Wash. Co. Sanitary istrict
(Form WCSC-1)
Replaces Form WCSC-56