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W, , WNGTON COUNTY SANITARY DISTRICT
33W.wASHINGTONSTREET HAGERSTOWN, MARYLAND 21741-0571 (301)791-3083/3084
P.O. BOX 571
PERMIT TO CONNECT TO PUBLIC SEWERAGE/W=8 SYSTEM
Permission is hereby given to:
For Property Located at:
0v01i0 Ni. P 2 fife
Owned by: Nn V P 1 1C) 11 P f D 1 F f o r Address
Type of Connection: To Service Connection
Type of Service: Residential
Commercial
Meter Size
6
PERMIT NO. '";`'
DATE
JUBDISTRICT NO. l5
KWIG iNSVILLE/GRL HILLS
To Main Line:
Units Other
Industrial
Connection Fee $620 • -0 U — Date Paid
To connect to a public sewerage/r 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 -Treasurers `
Building Permit No.
INSPECTION: At least 48 hours notice prior to requested date of inspection is required.
ON SITE INSPECTION will be made by
Permit Fee
Final Inspection Made BY:
Washington County Plumbing Board
33 W. Washington Street
Hagerstown, Maryland 21740
Telephone: 791-3146
Date 41— 17
Plumbing spector
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:
Final Inspection Made By:
DISTRIBUTION: Permittee 1 Plumbing Bo
Field 1 Off
Washington County Sanitary District
33 W. Washington Street-P.O. Box 571
Hagerstown, Maryland 21741-0571
3
Date
City of Hag. 1
WASHINGTON COUNTY SANITARY DISTRICT SANITARY SEWER LATE,,,':_
WASHINGTON COUNTY, MO. - `INSTRUCTION REC(W,'
Project: Mawgensv_ille/Orchard Hills Sanitary Sewerage Collection System_.^___
0510 ce-
Street (or location) : 6.d r jofd '46',643 D V, II ,
Contractor: _. Lisbon Contractors, Inc.
Date Installed f � .
UYE SIZE— TYPE PTH
SIZE TYPE PIPE C.O. C.O.
NOTES:
TER
St'd.
Drop
MH % T 0 MH. /._.._
Wye Ste. On Main 1A45 Fir.
NGTH
.32. OL. /=
a C.
LENGTH
*Horn.= Total
Ope + or2= Dr
Depth of Cleanout 7.45 ®Flow Line
Cleanout 8.! _. F rom i�- m4Iki
layed ®_7 %
- 00S5(6Lf Basement Service
Oh/LA)LID AV
MH# 1 is MH#
2'
2'` T�t3 Vicar.
Amounts pert ng to Work completed this period, reviewed and approved.
BY
UCS-D-Ins-pector Contractors Rep.
c- urcr_A )
Washington County Sartitary District
SEWER SERVICE LOCATION
Subdistrict No. SD#15
°[�f0 Sr»af(waodContract No. SD15- 3-S
Property Address: 6-4Q"Lani► fir;vP
MH 1015 to ISH 1016 DWG #601-365
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.
3
8°SAN.
- a �
CY
1024
(5)
Q
i
-- R/W —
MHSD 15 1016
g �it ios� R/W
I I
THRUST BL
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 �—r •�, L�Cp�� ,. .
Owner
Owner
Attest:
Wash. Co. Sanitary District
(Form WCSC-1)
Replaces Form WCSC-56