HomeMy WebLinkAboutELDON BLK 2 LT 16
~ INSPECTION APPOINTMENTS ~~ ~_~.
TIME ? TIME TIME
DATE . -
INSPECTOR INSPECTOR I NSP E~;~2~
MUNICIPALITY OF ANCHORAGE IHUNICIPALiTy C~F ANCHo/~AGE
t 'DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION._. DEPT. OF HEAI3'~ ~,
825 L Street - Anchorage. Alaska 99501 t;:~IVIROh, IMENTA--~"' ~
, /~L P~,OTECTION
ENVIRONMENTAL SANITATION DIVISION A[~ ~ 6 1981
Telephone 264-4720
D~IRECTIONS: Complete all parts ol~ page 1. Incomplete requests will not be processed. P ease a !ow ten (10) days for processing.-
1, PROPERTY OWNER k'! I PHONI~
MAILING ADDRES~S' ~
PROPERTY RESIDENT (If diffe?ent from above) PHONE
BUYER PHONj=
MAILING ADDRESS
3. LENDIN~ INSTITUTION PHONE
MAILING ADDRESS
REALTO 'AGENT /
5. LEGAL DESCRIPTION
6. TYPE OF RESIDENCE ~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
~ Two [] Five
[] Three [] Six
[] Other
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.)
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.
7~.10 (Rev. 6/79)
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 RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
uB IVIDUA~L/ON -SITE DATE INSTALLED
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
4, DISTANCESwELL TO: Septic/H°lding Tank IAbs°rpti°n Area Isewer Line INearest L°t Line
Absorption Area to nearest Lot Line
5. COMMENTS
.~ APPROVED FOR ~),,~BED ROOMS
CONDITION'AL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
