HomeMy WebLinkAboutPALOS VERDES BLK 7 LT 12
~~ . ',, MUNICIPALITY OF ANCHORAGE
,/f~"'~'~ DEPARTME~.__~OF HEALTH AND ENVIRONMENT.~,PROTECTION
~~.. 279-2511, ext~ 224 or 225
_.~,~ ~>~ Date Received:
~1: Time ~~ ~2: Time ~3: Time
e
Date
Date Date
Insp Insp
Insp _~_~_~___ _
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
276-3110/40
Lending Institution Request: Alaska Pacific Bank
Mailing Address: Post Office Box 420 99510 Phone:
Property Owner: Tommy L/Gay j. Stewart Phone:
Mailing Address: % Larry Luedke/Bowden Realty 278-3541
3. Legal Description: Lot 12 Block 7 Palos Verdes Subdivision
Number of Bedrooms: ?
Number of Bedrooms:
Community/Public System ~ )
Depth of Well Well Log on File ( )
BacterJ_al Analysis ~ .
4: Single Family Residence: (x)
Multiple Family Residence: ( )
5. Well. System: Individual well ( )
Permit #
Construction
Sewage Disposal System: On-site System ( ~ Public Utility ~)
Permit # Installed (~7~ Installer'
Septic Tank Size Manufacturer
Absorption Area
Soils Rate
MaterJ_al
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page. Two
Department of Health and Environmental Protection
Request for Approval. of Individual Sewer and Water Facilities
Legal Description:. Lo.t_~Qk 7 P~L~_3~BJ~iy£sion
Comments:
Affadavit Attached: ( ) Letter Attached: (
Disapproved: Date:
Department Worksheet:
M~NICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
VA _FHA
Tommy L. & Gay J. Stewart
Mailing Address:
Robert G. & Linda J. Griffin
3~ Name of Buyer:
Mailing Address: 100 Agate Circle
4. Name of Lending Institution: Alaska Pacific Bank
' ~' ' Mailing Address: P.O. Box 420 , ANC Phone:
5. Name of Realtor or Agent: Larry Luedke/Bowden Realty
Mailing Address:. 310 East Fireweed Lane Phone:.
6. Legal Description: L12, B7, PALOS VERDES SUBDIVISION
CONV...~X -.
Day Phone:
Day Phone:
452-1274
276-3110 X40'
278-3541
Location:
7~ Type of Facility to be Inspected: single family dwelling
No, Bdrms,
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
XXX
Individual
I.f Individual, depth of well.
Sewage Disposal System
Type of System:
If IndiVidual, date of installation
Public Utility
Individual (on-site)
***Please contact realtor to set up inspectionappointment
thanx.
AVENUE
PAL05 VERDES 5UBDIVI.SJON