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Home My WebLink AboutALYESKA BASIN #4 BLK 13 LT 15 Florence Fifth Floor F R O M .~ ~ J. (Harrison) Ward' Fourth Floor West SUBJECT DATE i i Lot 15 Block 13 Alyeska Basin July MESSAGE The following is not nee~e~ by the lending institution and I am request~g that you refund the $25.00 fee to them. Thank you for your efforts and efficiency! SIGNED REPLY SIGNED I~edif,~rm® 4S 471 SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. DATE POI. Y PAK (SO SETS) 4P 471 DETACH AND FILE FOR FOLLOW-UP MUNICIPALITY OF ANCHORAGE (.5 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL ~)F INDIVIDUAL WATER AND SEWFR FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete~equests will notyprocessed. Pleas lallow ten (10) days for processing. MAILING ADDRESS , PHONE R ~ " PHONE ADDRESS~, MAILING ADDR 5. LEGAL DES( / / 6. TYPE OF RESIDENCE / / SINGLE FAMILY // / [] MULTIPLE FAMILY / 7, WATER SUPPLY [] INDIVIDUAL* ~ COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOM8 ~ [] One [] Four I~] Other ---'-~ Two [] Five Three [] Six * 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. SEWA~G~/~ISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date. lq~7~) 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) t~UNICIPALI}Y OF ANCHORAGE DEPI. OF HEALTH & ENVIRONMEN'fAL k'R©] ~L.! lO '4 RECEIVED THIS SIDE FOR OFFICIAL USE ONL. DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 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: [] 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 AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] OTHER 5. COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) //