HomeMy WebLinkAboutROMIG PARK BLK 6 LT 12O01 I 0oo
APPLIC . NT FILLS OUT UPPER HALI 3NLY
Phone
Property Owner..~.~.~, % .~.'.~.~ ' -~. ~ - . t?~ .~.~. ~
Lending Institution ~ ~t ,g ~ ~'.?.~ - , ~ .
Address %,~,~ q, ,%'.v~r,~ ~-~b ~.~L~ Zip Code ~.
Legal Description ~ ~ ~,~,~t~ ~ L~ ~
Street Locati~ ~% ~) ~
Type of Resi~nce
~ Single Family ~
~ Multiple Family No. of Bedroo~ .
~ Other
Water Supply
~ Individual ~ ~ -~ ~ ~_ A~ACH WELL LOG. A wall log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal ~ ~3 ~
~ Individual ~ ~ ~ ~ ~ (, ~ ' ~ ~ ' ' Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank ~ ~pP~C~ ~(_ ~ ~ ~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
MUNICIPALITY OF ANCHORAGI
Field Notes: DEPT. OF HS/',LTH &
ENVIRONMF-NTAL PROTECI'~Oi'
RECEIVED
{ ~"'~ APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
< ) D,SAPPROVED
( ) CONDITIONAL APPROVAL'
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72.023