HomeMy WebLinkAboutCHESTER VALLEY Block 2 Lot 23
" '~: MUNICIPAL OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE
DEPT OF ~ ':ALT; &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(~viR ......
825 L Street - Anchorage, Alaska 99501 ONMENT.'LL ii:( i ~CTION
ENVIRONMENTAL ENGINEERING DIVISION JAN 2 6 1979
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWL~ ~/~_IT~E~u
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proceed. Please allow ten (10) days for processing.
1. PROPERTYOWNER, ~, PHONE~ ~'~
MAILING ADDRESS /
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS ~
3, LENDING INSTITUTION I PHONE
MAILING ADDRESS ~
4. REALTOR/AGENT ! PHONE
MAILI~ ADDRESS ~ ~~/'~(
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[~ [] One [] Four
SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY .'~ Three [] Six
[] Other
7. WATER SUPPLY
[] PUBLIC UTI LITY
* 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
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3~78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED ~ '-~ ' ,,
I NSPECTI ON APPOI NTM ENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SiX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
F-IPUBLIC UTILITY
Connection Verified
[]Septic Tank or I--1Holding Tank
Size: If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
Septic/Holding Tank IAbsorption Area
Sewer Line I Nearest Lot Line
5. COMMENTS
~~APPROVED FOR ---~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
JBY (Title)
Garland Tyner
1501-Patterson
Anchorage, Alaska
99504
FROM
i~SUB3ECT Lot 23 Block 2 Chester Valley Subdivision DATE 1 0 79
I am returning your check, as we do no~ have to make a physical
inspection of the property.
The certificate will be sent to the lending institution.
Thank you.
SIGNED Laura J. Ward
825 L S~eet 99501
264-4720
Redi~rm · 4S 471
Poly Pak I50 sets) 4P471
SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WiTH REfl. Y
DETACH AND FILE FOR FOLLOW-UP