HomeMy WebLinkAboutPALOS VERDES BLK 5 LT 20
~ MUNIC!PALITY OF ANCWD~GF
DEPARTME~:~OF HEALTH
825 ~ Street, Anchoraae. Alas~ 99501
264-4720
Date Received: September 26,1977
#1: Time #2: Time #3: Time
Date ~2~-7'~1~ Date Date
Insp !~t~O~-
j Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
3e
Lending Institution Request: Coast Mortgage Company % Judy/Kathy
Mailing Address: Post Office Box 1200 99510 Phone: 279-0665
Property Owner:
Mai~ing Address:
Richard Grant
Phone:
204 Meadow Creek Drive 99577
694-9813
Legal Description: Lot 20 Block 5 Palos Verdes Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Four
Number of Bedrooms:
Well System:
Permit #
Individual well ( Community/Public System ~9
Depth of Well Well Log on File ( )
Construction
Bacterial Analysis
Sewage Disposal System:
Permit # /~7~.~ ,
Septic Tank Size
Absorption Area
On-site System ( ) Public Utility
Install ed 6/~/'- '7C~ Installer Manufacturer
Soils Rate Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
%_/ ~
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 20 Block 5 Palos Verdes Subdivision
Comments:
Affadavit Attached: ( )
Letter Attached: ( )
Disapproved:
Date:
Date:
~epartment Worksheet:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ~,:, :,, , , .....
IV": REQUEST FOR APPROVAL OF
IDUAL SEWER and WATER FAClLITIES~
1. Type of Inspection: CMRO VA
2. Property Owner: ~ kC.,t,-~ ¢~'~ (~1~/o-~ 7--
FHA X' CONV.
Mailing Address: (;~OZ~ Z'~,~o.,--~c~.~
3. Name of Buyer: ~OOGO~
Mailing Address:.
4. Name of Lending Institution:
I' oo
Mailing Address: ~(:H ~ ~ ~/~
5. Name of Realtor or Agent: ~ ~ ~ c ~ ~/'~
Mailing Address: ~' o.
6. Legal Description: ~ ¢~
o
Location: ~ ON /~ (..~ 0o~.,
Type of Facility to be Inspected:
Day Phone: ~-~ 7?, w~' (f g/
Phone:
No. Bdrms ~ F*~> ~ ~-- ~,,~,c,,o
Water Supply
Type of Supply:
Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
.Individual
Sewage Disposal System
Type of System:
If Individual, date of installation
Public Utility
Individual (on-site)
72-003(3/76)