HomeMy WebLinkAboutSAMUELSON LT 4� ka
�
GAAB-HD-1 S�GREAT-FF INCHORAGE ARE TROUGH`
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279 511
Base No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF
APPLICANT Id J QO MAILING ADDRESS a � � PHONE NO%—�S3b
RESIDENCE ADDRESS
LEGAL DESCRIPTIO
LOCATION OF INSTALLATION &ON/c L 0Ic �� r� I
IL, 41P
APPLICATION TO INSTALL: SEPTIC TANK ✓ , SEEPAGE PIT ✓ , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY a 3 ) l`Nl
FINANCED THROUGH S2 LC�' TO BE INSTALLED BY
-MfAL� Ff3N--TEST RESUL
3441,309 DR 34413209
ANTICIPATED DATE OF COMPLETION D 4 � r Aiy "ce
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS M le 1 01 ®YEN&0nJ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .2
SEPTIC TANK SIZE 2c50- TYPE&ZILeA/L SEEPAGE AREA
YIl1Y 1V"IIYI VI VIJI LIYI
DISTANCES: Show o
L.rMi'T- No -r VA( -,D
W 0tj 1 So,/_ TEST.
//, a, e
S" pA,oX� -?r�e
XT 7po I N i D )
E
t,L i1V
Health Authority
TYPE -ZLJ
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE �� APPLICANTS SIGNATURE - .�
1
4
w