HomeMy WebLinkAboutALYESKA BASIN #6 BLK 22 LT 1I
APPLIC ~iT FILLS OUT UPPER HAt ONLY
ProPerty Owner "--~-/':.: , ,,/' ~"i-~'"" '~ Il j' ~::~:( :(:~-,D ~'~ /": ' Phone
:''.~ ~-/ Zip Code '
, .. . ( ¢. :':-'[~.,_,: :~_ t. .
Buyer
Address ., Zip Code
t::~: .~'~ . . , , Phone
Lending Institution /L~ : L4'-Z'/~ F7~ L._..~{ - ~*!~: ~, r', F .ql &. ?
Address ~O( :, c ~"~ (-~ ~ ( ~ Zip Code
Realty Co. & A~nt. Phone
Address Zip Code
Legal Description ~::,t,, =.'~ ~ ~:~::~. ~ L,2 :' t lq
Street Locati~
Type of Resi~nce
'~Single Family
: Multiple Family No. of Bedrooms
: Other
Water Supply
: Individual ATTACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
: Public Utility ~ O ~_
Sewer Disposal
: Individual Year Individual Installed:
Public Utility When Connected to Public Utility:
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OGESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF H~AL]'H g':
FNVIRONM~NTAL P/~OTECTION
RECEIVED
( ~ APPROVED BEDROOM8 *CONDITION8 OF APPROVAL
( ) DISAPPROVED
( ) CONDItIONaL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
72.023 (3182)