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SEWAGE DISPOSAL SYSTEM - APPLICATION g PERMIT
Name of Applicant...~ , ~' //~ ~ Z Mailing Add~ess
Residence Address 5~ LocaZion of Installation
Application to Install: Septic tank,, , Seepage pl~, Drain fieid~, ~her
To Serve the Following Facllity ~ ~.~' .~.~%?z~ ~cc~
Financed Through ~,; ~
/~;%~ ~f~3. To be Installed by
Pemcolation Test Results ........ Anticipated Date of Completion
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
This is to semve as
_._~ _ a~ described below.
......... · t~Dtic tank size
DISTANCES:
~alth Authority
, permit to install a
Size of unit to be served
_Type_.____Seepage Area____ , ~Type. _ ._ ~
DIAGR~M OF SYSTEM,
I certify that I am familiar 'with the requirements of Greater Anchorage Area Borough
Ordinance No. 28-68 ar{d ~ba~ the above described system is in accordance with sa~d code.