HomeMy WebLinkAboutT12N R3W SEC 15 LT 30
DISTANCES
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Name of Applieant.~~~ Mailing Address V~ /--:
Residence Address ~ % h~l:_ Location of Installation
Application to Install: Septic' lank~b
Seepage p~t~ D~a~n
To Serve the Following Facility >~-/4,, ~_, ~>,0,/~/~:,>~ (
Financed Through ...... To be Installed by ~/~r. /~
Percolatio~ Test Results. /"~_ lA.,~' ~'( ~ ~ ~ /'~"~"
BELOW TO BE FILLED OUT BY HEALTH DEPARTgENT
This is to serve a i , ,'~_ . ~/,~, permit to install a
/}5:~s described below. Size of unit to be s*rved
DIAGRAM OF SYSTEM
I certify that I am familiar with therequirements' of Greater Anchorage Area Borough
Ordinanse No. 28-S8 and that the ~ovs described system is in accordance with said code.