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WAS:IINGTON COUNTY SANITARY DISTRICT
33 W. WASHINGTON STREET HAGERSTOWN, MARYLAND 21740 (301) 791-3083/3084
PERMIT TO CONNECT TO PUBLIC SEWERAGE/WATER SYSTEM
Permission is hereby given to: ' (9( a
For Property Located at: _
PERMIT NO.
DATE
SUBDISTRICT
Owned by: Address: ' r
Type of Connection: To Service Connection ` To Main Line:
Type of Service: Residential ( �) Units Other
Commercial _ Industrial
Meter Size
'6 0
Connection Fee
Date Paid
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
Plumbing In ctor
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: Perm
Plumbing Boa
Field Offi
WASHINGTON COUNTY SANITARY r TRICT 1ANITARY SEWER LAT[i-:;_
WASHINGTON COUNTY, MO. ..ONSTRUCTION RECOPY!
Project: Mauoineyril a/Orchard Hills SanitarX Sewerage Collection SYetem
Street (or location): r -7,4r 7310 lie PEtr�ArZ C.�2c.lk % ��d1�t
Contractor: Lisbon Contractors, Inc. i
MH 5776 -TO-Aw ("--1 ( OZ 9
Date Installed Wye Sts. On Main• o+Do Fi4.
k! VAJc ^-
CoAd&JeC7
TO
M. H.
NOTES:
':!;.09 ZG AIC,
LENGTH
ftrz.= Total
19,75 1.:F.
11ops ort•
n
Depth of Cleanout 'z-+5 •flow Line
Cleanout 1-7,-75 rom-*-:M41&,1 ~"
layed • Z
• r� F, Basement Service
Rj A
loz� MM�578
:s
bz
Amounts pertaining to work completed this period, reviewed 04 approved* f
Ica
Inspector Contractors Rep,
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Al S+ojN�IJ �oCr}T, o., . Nt w l ocAT oN
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C9.v0-TI 0.4 1,
Washington County Sanitary District
SEWER SERVICE LOCATION
Subdilstrict No.
SD#1 5
),A--rEXAL )*.,To A4)4 ' 5,78 & /OZ
Contract No. SD15- 3-S
Property Address: bo petmar Circle tree v
MH 578 \ DWG. #601-308
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.
XMH Sp15-578
( r
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: l �0/Ij- a 4e.o uO�7�
Owifer
,/ r7 w
Attest: / (Q �1
Was Co. Sanita District
(Form WCSC-1)
Replaces Form WCSC-56