HomeMy WebLinkAboutLat_14106TarheelCourt,°N 2 WASHINGTON COUNTY
WATER & SEWER DEPARTMENT
16232 Elliott Parkway , j to /31 CA
Williamsport, MD 21795 ^^nj-'.,..r
��RYLrNO
(301) 791-3083
Permit to Connect to Public Water/Sewer System
150 - I q Coo
Type of Permit RES ;EWER Permit No. SCP
Subdistrict Name Issue Date O `? / 2 o'` � w
Mainline Contract No. Void Date 09/20/01
Building Permit No. + ;; I s Subdistrict No. 1 0
Permission is hereby given to:
Property Owner: DA'. ' D SHAT , 1;
of address:
HA':ER1',TC)W14 MD 1.1.740
For property located at:
Lot No. 1,11 1 Subdiv.
Owner's Agent: _
Agent's Address:
Previous Owner:
Street Address
Phase - Sec.
11029 PLUMWOOD CIRCLE HAGERSTOWN MD 21740
Fees Paid in Full? YES Lateral with Mainline? YES
Date Fees Paid Residential EDU's
Fee $ Commercial EDU's
WCWSD Alloc./Conn. Fee $ 62 1 3U Gal/Day Allocation 200
WCWSD/Other Fee $ Building Number
City of Hagerstown Fee $ Misc. Number
Total Fee $
Remarks
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-
MAIY-T�
THE PROPERTY OWNER.
Sign' Date: Z o a
i
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: • g!J Plumbing Inspector: 1(
�"ASK
PROJECT NAME:_- ' yynt;al'n (%%cz�✓ �✓�✓�i ornss' PROJECT NO:
PROPERTY ADDRESS: 7-/-.,/ !t2- DRAWING N0: /a
FAIN LOCATION: STREET/EASEMENT DATE INSTALLED:
PROPERTY OWNER NAME: MH /-��-12611 TO MEI X5-0 --/a&`-
PROPERTY OWNER ADDRESS: MAIN STATION: - lf'(�,o R16flT
SINGLE: DOUBLE:
CONTRACTOR: Cc'i✓ldc�.^�� � � //.�y CONNECTION ®MH:
SIIZZEE�,& TYPE SIZE & TYPE
Ly/WYE DOUE3I_E TEE
2
E (RT) F(Lr)
SIZE & TYPE INVERT a DEP 111
SERVICE PIPE MAIN C/0 A E3 (LT) c (LT)
F - - - 13 (RT C (EI T)
V
�
NO SCALE (RT)
WE, THE UNDERSIGNED, BEING SAID OWNERS OF THIS PROPERTY, REQUEST PERMISSION TO INSTALL THE
(PROPERTY ADDRESS)
DATE:
(OUSE LATERAL AT THE MODIFIED HEIGHT DESCRIBED ABOVE.
ATTEST:
WASH INGTorr CUUNf� WATCR & SEwLP DEPT
PRIN lED tJniv1L
1A T ITP`
THIS FORM SEfALL BE USED IN CONJUNCTION MITI THE GRAVITY SEWER SERVICE CONNECTION SHEET,
STANDARD DETAIL S-3.3.
DIVISION OF PUBLIC WORKS
WA511NGTT)N COUNTY, A41R12ilND
WATER AND SEWER
MODIFIED SERVICE LATERAL
R' `kGRAVITY SEINER
GS,o
DEPARTMENT
JANUARY, T tree S -13-3A