HomeMy WebLinkAboutHOLLYS HOLLOW LT D
~' ~- r DATE RECEIVED
INSPECTION APPOINTMENTS
TIME~ TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE P. EPT OF
I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTL~ij~
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE
DIFIECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
John & Jackie Boyle 333-5676
MAILING ADDRESS
:PO Bo× 390~ girdwood~ Ak. 99587
PROPERTY RESIDENT (If different from above) PHONE
PHONE
2, BUYEFI
Ja~ 1vi. Carter ~one
MAILING ADDRESS
3209 So. 101 E. A~er ~lsar O~
3. LENDING INSTITUTION J PHONE
National Bank oE Alaska io,~th T.aBar~J 226-1132
MAILING ADDRESS
301 W. Northern Liqht$ Bl~d.
4, REALTOFI/AGENT J PHONE
Jack White Co. Jack Vanden BergJ 277-1553
MAI UNG ADDRESS
3201 C St.~ Anchorage, Ak. 99503
5. LEGAL DESCRIPTION
Lot a of Lot 63, U.S. Survey 3043 (Holly's Hollow Sub.)
s'~-R EET LOCATION
NHN Nancy Circle, Girdwood
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four [] Other~
[] SINGLE FAMILY [] Two [] Five
[~ MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY [] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) 48 ~
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY ,~ ,
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG R ECEIV ED
PERMIT NUMBER
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[~ PUBLIC UTI LITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
WELL TO:
Absorption Area to nearest Lot Line
5. CONIMEN~S
[~APPRovED FOR ~ f BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED