HomeMy WebLinkAboutEAGLE RIVER HEIGHTS NORTH BLK 13 LT 10- iXlor th
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MUNICIPALITY OF ANCHORAGE EAGLE RIVER AREA
DEPARTME-- OF HEALTH AND ENVIRONMENT'-. PROTECTION
855 L Street, Anchorage, Alas._a 99501
279-2511, ext. 224 or 225
Date Received: May 10, 1977
#1: Time /~3k*{~71 #2: Time #3: Time
Date 5- ~;~77 ~/~s. Date Date
Insp ~ Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: National Bank of Alaska % Ruth
Mailing Address: Post Office Box 3-3859 99509 Phone:279-2506
2. Property Owner: John Delaney
Mailing Address: Post Office Box 684 99577
Phone:694-2398
3. Legal Description: Lot 10 Block 13 Eagle River Heights North
4: Single Family Residence: (x) Number of Bedrooms:--3~/~~-
Multiple Family Residence: ( ) Number of Bedrooms:
Well System.- T~vidual well ( ) Community/Public System (x)
Well Log on File ~/~
Permit ~ ~~~ Well
, / , ·
Construction Bacterial Analysis 0! ~ ·
6. Sewage Disposal System: On-site System ( ) Public Utility
Permit ~ ~2~ /~ Instal~ /~ ~aller
~ M~f~t~rer" ~
Septic Tank Size ~i × ~ ~Le
rial
Absorption Area ~il
7. Distances: Well to S~ Tank ~ /?~ ~ ~-~ Absorption Area
to Sewer Line N ~ ~ ~ /~ Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of InspectioB<~-'~ VA FHA
2. Property Owner: ..... ~ " C-'¢~--- ~-~-'-~--~z~
Mailing Addr/~s/: ~ ,/z~, ~, ~/~,~, Day Phone:
A;UNICIPALiT¥ OF ANc~ ~-_
DEPT. OF HEA~.TH , '~'
P~,O, ~1~N
RECEIVED
Mailing Address:
Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
Day Phone:
Location:
CONV.
7. Type of Facility to be Inspected:
No. Bdrms.
Water Supply
Type of Supply: Public Utility.
If Individual number of dwellings presently served
If Individual depth of well
Sewage Disposal System
Type of System:
.Individual
Public Utility J Individual (on-site)
If Individual, date of installation
72-003(3/76)
Pay? ~o
° Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water FacLlities
Legal Description: Lot 10 BlOck 13 Eagle River Heights North
Comments:
Affadavit Attached: · (')
Approved:
Disapproved:
Letter Attached
Date:
Date:
Department Worksheet: