HomeMy WebLinkAboutBROADWATER HEIGHTS Block 5 Lot 2
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F..:OGER NE'FTL. O!,.I
229:51<h"L I NE DF.'.
[_2, B5 BROFtDI,.tFITER FIT:::]
!"t I N I MUM
:.t..~;.']ff:!) F:'EET FOR Fl
UF'ON THE T'¢F'E OF:'
M I h! I MLff'! E:, I S TFINCE
"r'c !::I f":t] MMI..tI',I I T"r'
HELL. LOGS FIRE
OF' THE .I.,.I[EL.L COMF'LETI
OTHER REC.!I..t I REMEI",ITS MFt"¢
FtVF!tL. FIE;L..E TO Ih!SURE
BE"f'!.,.tEEI',I FI P.IEL. L RN[.',
;:I',,,'FfTE HELL. OR 1.5'k::.~ TO
UBLt E: k!EL.[ ....
)I"1 R PR I ',/FITE I.,.tEL
L.!NE IS '75
FIN[:, HUST
S R;2'- }%~'. 29.
I TE SE!.,.!FIGE [:, I S:;F'OSFtL. Sh.'S:;'TEM I S
EET FROH Ft F'UBLIC P.!EL.L [:,EF'EN[:,ING
F'RIVFtTE SEt~ER LINE IS ;.25
TF THE [:,EF'FIRTMENT 1.,.t I 'r!.-t I [' ¢:lh-'S
S RN[:, COI',kE;TRUCTI RE
I C:ERT I F:'h" THFIT
::L: I RH F:'RI'dILIF!R I,.IITH
F:'ORTH [.:.,".¢ THE MLtN I C I PFtL
2.".: ! !.41 L.L. I NSTFILL.
:.::':
OF
If',
. F-. ON-S I
thlg, t4EL. t...S FIS SET
:['.:!!;SUE!:) E',h.'. ...........
DATE RECEIVED
...... ~' INSPECTION APPOINTMENTS //
'TIME TIME TIME
x
MUNICIPALI Y OF ANCHORAGE MUNICIPA[I~ OF ANCHO~GE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT. OF HEALTH &
825 L Street - Anchora~, Alaska 99501 E~IEONMENTAL P~OTECTION
ENVIRONMENTAL SANITATION DIVISION NOV 9 1981
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be proc~d. Please allow ten (10) days for processing.
1. PROPERTY OWNER ~ PHONE
M~LING ADDRESS '
PROPERTY RESIDENT (If different from above) I PHONE
2. BUYER PHONE
MAI IING ADDR ESS
3. LENDING INSTITUTION I PHONE
MAI LING
4. b~AL/O8/A~NT PHONE'
MAI LiNG ADDbESS
5. LEGAL DESCRIPTION
JSTREET LOCATION/'
1 6. TYPE OF RESIDENCE
/~ SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY ~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] FiVe
Three [] Six
[] Other
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give welt
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
'~1 N DIVI DUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE
[] TWO
NUMBER OF BEDROOMS
[] THREE [] FIVE
[] FOUR [] SlX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL ·
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: /~)(~)O If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
MATERIAL
Absorption Area to nearest Lot Line
5. COMMENTS
Septic/Holding Tank
Absorption Area
ISewer Line
Nearest Lot Line
DATE
.~t~PPROVED FOR~~____ BEDROOMS [] CONDITIONAL APPROVAL (letter must/a)ccompany certificate)
~ DISAPPROVED ~ t.._ ~/~
72-010 (Rev. 6/79)