Originally, the Sanitary District started in 1959 in Princess Anne where the town manager oversaw the water and sewer service. About 1975, the responsibility for the service was transferred to County government. Besides Princess Anne, the Sanitary District today includes five subdistricts: Crisfield, Fairmount, Rumbley-Frenchtown, offshore Smith Island, and Westover.
Appointed by the Board of County Commissioners, the Sanitary District Commission consists of five members who serve six-year terms. The Chair is chosen by the Sanitary District Commission from among its members (Code Environment Article, sec. 9-622).
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