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V'AShf1^NGTON COUNTY SANITARY DISTRICT
33 w.. HI ;TON STREET HAGERSTOWN, MARYLAND 21740 (301) 791-3083/3084
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
To Main Line:
Units 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 I
Final Inspection Made BY: ' Date `
Plumbing Inspe r
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:
DISTRIBUTION: Permitt
Plumbing Boa
Field Offi
Date
,ASMINGTON COUNTY SANITARY DI RICT
WASHINGTON COUNTY, MO.
NITARY SEWEn LATE'."
LONSTRUCTION nEC01�r!
Projects Mouamnsvi119,/Orchard 111116 :ianitiarr gay r■ev �vs♦�+.� +•�_--
f 3 76u,
Street (or location) t , r,41 �Qf e0y4L Rodes --
Contractor: Lisbon Con r -"fora. Inc. -
Date Installed e4--
WYE
P C.O., ATEA
PSL. s• ZOv. F. St 1 d.
NOTES:
MH -s4 TO MH X4.3
Wye Sts. On Main 2t17 L-
.
Drop 1 25.90 (-.;:
Depth of Cleanout e- 20�_Oflou Line
Cleanout from MAW
Loynd 41...C.-.—% AFTeR D201-
• ac%mss, -, . Basement Service
2 54L, b P
PW X44-
LENGTH _._..
orz.- Tots),---
Depth
ota),=
-e-85+ 2U. lGz ZZ.99
• L.F.
1 s4 3
Amounts pertaining to work completed this period, reviewed and approved*
BY
inspector Contractors Rep.
IL
Aalk Ad0k
Washington County Sanitary District
001h` SEWER SERVICE LOCATION
Subdistrict No. SD#15
. Contract No. SD15- 3-S
13 -toc�
Property Address: -2-3-2-1- Royal Road
-144
MH 5'to MH-- DWG. #601-306
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.
18''
trG►r O'fiUt- -1
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.
r
Date:
Owner
Owner
Ate'
Attest: )L' i-- U,
Wash. Sanitary District
(Form WCSC-1)
Replaces Form WCSC-56
5 '13 - ---, "'I
WASHINGTON COUNTY SANITARY DISTRICT
33 West Washington Street, Hagerstown, Maryland 21740 ■ (301) 791.3083
To: Lisbon Contractors, Inc.
RECEIVED
WAVINCTON COUNTY
SANITAr�Y CUNIallbSION
INSPECTOR ATE
I hereby request the contractor to install the lateral in
accordance with the following conditions:
Address 073,0-1
Signed0i 5� !
r per y wner /
9, I .
Washington County Sanitary District
33 West Washington Street
Hagerstown, Maryland 21740
Re: Maugansville/Orchard Hills Sewers
Contract No. SD15-3-5
Gentlemen:
We hereby request permission to install the house lateral
of greater than two (2) percent and/or in accordance with the
above conditions at no change in contract price at the following
location:
f i M 41 3 C vvi Q A - -r -% -r4 C-
-4-vy wap
Requested by Lisbon Contractors, Inc.
Approved
by
W.C.S.D, Inspector �.
9�.jm `J
Date