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WASHINGTON COUNTY
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3 WATER & SEWER DEPARTMENT
J I o e3 01
16232 Elliott Parkway "ncur
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Williamsport, MD 21795
(301) 791-3083
Permit to Connect to Public Water/Sewer System
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 -
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: % ' L �� Plumbing Inspector:
iso-1yr70
Type of Permit
RES SEWER
Permit No. SCP
Subdistrict Name
Issue Date
Mainline Contract No.
Void Date 09120101
Building Permit No.
P2000 -i838
Subdistrict No.
Permission is hereby given to:
Property Owner:
DAVID SHAOOL
of address:
11029 FLUMWOOD CIRCLE
HAGERSTOWN
MD 21'/4U
For property located at:
Street Address
Lot No. TH7
Subdiv. FOUNTAINVIEW
Phase
i Sec.
Owner's Agent:
DAVID SHAOOL
Agent's Address:
11029 PLUMWOOD
CIRCLE HAGERSTOWN MD 21740
Previous Owner:
Fees Paid in Full?
YES
Lateral with Mainline?
YES
Date Fees Paid
Residential EDU's
Fee $
Commercial EDU's
WCWSD Alloc./Conn.
Fee $
Gal/Day Allocation
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 -
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: % ' L �� Plumbing Inspector:
PROJECT NAME:
ova � i f � �✓� o�nrs,
PROPERLY ADDRESS: 7W 7 40` PROJECT No:/, 0 _ 6
MAIN LOCATION: STREET/EASEMENT DRAWING N0: /a
PROPERTY OWNER NAME: DATE INSTALLED:
PROPERTY OWNER ADDRESS: MIIl— 12W TO MN /sO-/a65"
MAIN STATION: �'t`�`-riQ��rYt
CONTRACtOR: G'ci,.,�j�•/�., d (����, SINGLE: _______ DOUBLE: l--'
CONNECTION ® MN:
SIZE do TYPE slZr_ do TYPr st7r h Imr
C':O'YE Dvut3t_r } _-, wY= srIlVlcr
1111,17
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NO 5CnLE: � I t" �
WE, Tllr UNDERSIGNED, BEING SAID OWNERS OF TI IIS PIiOPERTY, REQUEST I)LrZMiSSiON 10 IN
5TA1_L THE
("OPT. n T Y AL)DrE cS )
DA TE:
e --J
ATTEST:
IOUSE LATERAL AT TIIE MOUIrIEU HEIGHT DESCRIBED ABOVE.
WASIIINI;TVM CUUNIN WATER SEWLn DEPT
r�rlNlr_1) Nn;,�E
SICCA IIJT->`-
T14IS FORM 511Af_L dE USED IN CONJUNCTION WI111 THE CI7nViiY SEWER SERVICE CONNECTION
STANDARD DETAI11 L S-3.3. T
11 SHEET,
DIVISION OF PUBLIC WORKS
W,ISHINGMy COUNTY, ANR1U1V0
WATER AAND SEWER MODIFIED SERVICE LATERAL
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JANUARY, I O.qtI
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