Loading...
HomeMy WebLinkAboutSHADY LANE BLK 4 LT 8S-,, HAdy LAisl e. # 066 173 zlq 61t> r � • 5. LEGAL DESCRIPTION ` DATE RECEIVED INSPECTION APPOINTMENTS TIME TYLPP� TIME TIME DATE - - DATE DATE 1 � Three ❑ Six 7. WATER SUPPLY INSPECTPR * ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR X PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE DEPT. OF 1'=ALTH & PROTECTION: 8. SEWAGE DISPOSAL SYSTEM DEPARTMENT OF HEALTH & ENVIRONMENTAL PROfli&�WIMENTAL 825 L Street - Anchorage, Alaska 99501 • DEC 1979, ❑. PUBLICUTILITY ENVIRONMENTAL SANITATION DIVISION - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Telephone 264-4720 RECEIVED ECEI\/CD . REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER - PHONE / 3 MAILING ADDRESS f PRO ER Y RESIDENT (If different from above) PHO E 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT Gtr Tv IQ >y�"- PHONE .974-a33 MAILING ADDRESS p(!�y'�l�(Q �./'(Y}�%f hn7 Ar 11 5. LEGAL DESCRIPTION Av- — q L=A CLL.)L, STREET LOCATION /S' 6. TYPE OF RESIDENCE NUMBER OFBEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well X PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM bt INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑. PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) t� 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION. AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 6. COMMENTS C3y... ❑ APPROVED FOR BEDROOMS FC,CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY t� 72-010 (Rev. 6/79)