HomeMy WebLinkAboutMAJESTIC VIEW BLK 1 LT 21
~-" -- ยท DATE 'F{ EC~-~ED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSPEC'~ i\ INSPECTOR INSPECTOR
MUNICIPALITY OF AN~Or~AG[
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION OCT A 2 1979
Telephone 264-4720 R E C E
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
~DI RECTIONS'. Complete all parts on page 1. Incomplete requasts will not be processed, Please allow ten (10) days for processing,
J PHONE
MAILING ADDRESS
2. BUYER ~r~ 5~t~ PHONE
~A~L,NG AODR~SS
3'; LENDING INSTITUTION PHONE
MAILING ADDRESS
4. REALTOR/AGENT
MAILING ADDRESS
5, LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
,/~ E~ One [] Four
SINGLE FAMILY E~] Two F"] Five
[] MULTIPLE FAMILY '~ Three [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010 (Rev, 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Veiifled LOG~RECEIV ED
3. SEWAGE DISPOSAL sYST'EM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
~PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev, 6/79)
