HomeMy WebLinkAboutCALAIS BLK 5 LT 6000 DATE RECEIVED APPOINTMENTS INSPECTION ~.~~- ~/~,'~ ~_' DATE MUNICIPALITY OF ANCHORAGE MUNICIPALITY CF AF.!CHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT MI "~:F'T. :. 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION t": ["~ Telephone 264-4720 o. ,..,V,OUA. DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing, 1. PROiPERTYOWNER I PHONE MAI LIN G/ADDR ESS PROPERTY RESIDENT (if different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE [] SINGLE FAMILY [;;~'-MU LTIPLE FAMILY NUMBER OF~BEDROOMS [] One _.[~'" Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY E~ 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. 72-010 (Rev. 6~79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] TWO NUMBr~R OF BEDROOMS [] THREE [] FIVE [] FOUR [] SlX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding 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 Absorption Area [Sewer Line Nearest Lot Line 5. COMMENTS /,.:.)~ ยท ; t DATE [~.~/APPROVED FOR /' ~' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED .... / I BY / . 72-010 (Rev. 6/79)