HomeMy WebLinkAboutALYESKA #2 BLK 16 LT 9
APPLIF '.NT FILLS OUT UPPER HA ONLY
Phone
Realty Co. & Agent '~ ~, (~. ~ ~ ~: .....
Address t Zip Code : ~. ~:; / (: /
Type of Resi~nce
.~Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A wall 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
Sewer Disposal
~ Individual Year Individual Installed:
~ Public Utility
~ Holding Tank ~ ~--~~ ~_~~
NOTE: THE INSPECTION FEE MUST ACCOMPAN~~ EACH RE~ES~~ BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT, OF HE/',LTH &
ENVIRONMENTAL PROTECTION
RECEIVED
( ~J'~APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APE.~OVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)