HomeMy WebLinkAboutLot 02
·" "' MUNICI'PA[ITY OF ANCHORAGE
~t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ... ., ~. ~1~
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION '. ~
Telephone 264~,720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for ~)rocessing.
PHONE
1. PROPERTY OWNER
Big Three Lincoln Alaska, Inc. 276-1216
MAILING ADDRESS
6415 Attic Blvd., Anchorage, Alaska
~ROPERTY RESIDENT (If different from above) PHONE
PHONE
2. B~o~ert H. and Catherine L. Sharp 337-2935
VIAl LI'NG ADDRESS
8200 Pioneer Drive, Anchorage, Alaska 99504
3~ LENDING INSTITUTION I PHONE
Alaska Bank of Commerce 279-5641 ext.
I
MAI'LING ADDRESS
Pouch 7012, Anchorage, Alaska 99510 Attn: Janet R/E C Street Branch
4. REALTOR/AGENT I PHONE
Sue DelaneyI 276-1560
MAI LING ADDRESS
3bO K Street, Anchorage, Alaska
5. LEGAL DESCRIPTION
Lot 2 Block i Alyeska Basin S/D
STREET LOCATION
NHN Davos Drive, Anchorage, Alaska 99587
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other~
I~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
I--I INDIVIDUAL*
rX-I 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
.... e ' 1972
If md~v~dual/on-s t , g ve 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(3178)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION' APPO I-NTM ENTs
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR !INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AR EA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] OTHER
Septic/Holding Tank
IAbsorption Area
Sewer Line
INearest Lot Line
5. COMMENTS
[] APPROVED FOR BEDROOMS
~DITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
I BY (Title) ~
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)