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Home My WebLink AboutSHADY LANE BLK 5 LT 3SH44ay LANA- SIO oblo C, '5 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME V TIME 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY j LCL eft ri._A DATED ATA DATE r� 7. WATER SUPPLY ❑ INDIVIDUAL* INSPECTOR INSPE TOR INSPECTOR '& CHORALE ;i8 PUBLIC UTILITY depth (attach log if available.) MUNICIP k�F MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL P".OTLCTION DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ;981 1 � J U! ENVIRONMENTALTelephone 264-4720 DIVISION RECEIVED �? NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATID.dnn 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 .L. 4,nom.✓ �Q3 PHONE - X880 MAILING ADDRESS 4'711 /�//d�l Sf r/G p E G.rIS �A S� 5� PROPERTYRESIDENT (if different from above) PHONE 2. BUYER 1 0 2 PHONE —D72 3/33 MAILING ADDRESS 3. LENDING INSTITUTION PHONE l/3 2 - MAILING MAILING AD KESS ,g 4. REALTOR/AGENT PHONE ti / G /9�2 /s -22- MAIL'ING ADDRESS Sad uJ 5. LEGAL DESCRIPTION 0 3 B/ STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY EI One ED Four El Other ❑ Two .EJ 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 ;i8 PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - J?7 INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. //i5W ❑ PUBLIC UTILITY- ISG c�eLP_ — S�U� ��tJLt r�i-�l 1fDS - 11�LI=gi �? NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATID.dnn 72-010 (Rev. 6/79) J�� ( 1, / I 7'_D Q,s>nLslw.� LA A u L.tv 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 DATE INSTALLED 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 5. COMMENTS V' APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE �J BY 72-010 (Rev. 6/79) SAM £325 ,; L,. ST R E z T ANCHORAGE, ALASKA 99501 (90 4 2604111 GEORGE. M. SULLIVAN, - MAYOR CEPAR?"WE=NT OF HEALTH AND ENVIRONMENTi0- PROTECTION July 7, 1981 A.L./Lynn Hager. 6711. Mink Street Anchorage, Alaska 99504 Subject; Lot. 3 Block 5 Shady Lane Subdivision Approval for the sewer and water facilities cannot be granted until the following is completed: Public sewer is available to the above property. Prior to this department's approval, the property must be connected to the public sewer and verification o0 the connection submitted to this office. The on-site sewer system will need to be abandoned and caved in with dirt, if there are any further questions, please call this office at 264-4720. Sincerely; Robert C. Pratt, R.S. Associate Specialist RCP/l jw cc; National Hank of Alaska % Y achy Claiborne Pouch 7-w025 99510 Rick Jarvis % Dynamic Realty 501. West Northern Lights Boulevard 99503