HomeMy WebLinkAboutdoc07592720260115140403MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 021-021-40
Complete legal description Canyon View Estates Block 1 Lot 7
Location (site address) 13783 Canyon Road
Current property owner(s) Hultquist Homes, Inc. Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well serving # 1 dwelling units
El Other Non-public well as regulated by MOA F-1 Water Storage
El Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: � Private Septic F-1 Private Septic serving 2 dwelling units
F-1 Holding Tank El Community Septic or Public Sewer
5. SEPTIC TANK: * Steel 0 Plastic R Concrete R Fiberglass
Age <1 - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: 0 AWWTS F Bed E] Deep Trench FE Wide Trench F Seepage Pit
Waiver request for:
Expedited review requested: F-1
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $1 Waiver Fee $
Date of Payment j -3/2L, Date of Payment
COSA Waiver #
COSA App1icat1on_Apr2025.doc