HomeMy WebLinkAboutTHE LANDINGS BLK 1 LT 9Jun 30 11 04:56p Beau Maxim 19073391985
Mark Begich
Mayor
Developmen? Services Department
Building Safety Division
On-$ffe Wafer & Was'fawn?er Program
4700 Elmore ~oad
P.O. Box 196650
Anchorage, AK 99507
www.muni.orq/onsit¢
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Date of Issue:
Parcel Identification Number:
Legal Description
THE LANDINGS 8LK: 1 L-F 9
ilProperty Owner Name & Address:
IJIM PLYMIRE
16245OLD SEWARD HWY
IANCHORAGE, A~ 99516
Pump Installation Date: 6[01/11
Pump Intake Depth Below Top of Well Casing: 40 feet
Pump Manufacturer's Name: GOULDS
Pump tV[oriel: 10SB05422C
Pump Size I/2 hp
Pitless Adapter Burial Depth: 1o feet
Pi?less Adapter Manufacturer's Name: CA~BEL
Pi?less Adapter Installer: N/A
Well Disinfected Upon Completion? ~ Yes [] No
Method of Disinfection: RECIRCULATED USING CH LORINE PELLETS
Comments:
Pump Installer Name: BEAU MAXIM
Attention: The pump installer shall provide a pump instal lation log to the DSD within 30 days of pump installation.
GR' TER ANCHORAGE ARFA BOROIJ~H
DI;,ARTMENT OF ENVIRONMENTAL QUALI~,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION RLzPORT ON-SITE SEWAGE DISPOSAL SYSTEM
DISTANCE FROM WELL ~"Z2 '
NUMBER OF
MATERIAL ,/~/~'-~'-'"~,¢'--~'~ ~';~?-4/~'&'''~'D~'~-''- .COMPARTMENTS.
~ / L~I~IID~ .~ ,~
LIQUID CAPACITY /'~"~ GALLONS. INSIDE LENGTH_ /'-,>;' INSIDE WIDTH. ~J"~" / DEPTH '.~
SEEPAGE PIT:
SEEPAGE
SYSTEM:
:~OR~ WIDTH , LENGTH__ , DEPTH__
DISTANCEFROM~LL ~---~--~,, ~0'~L~tNG FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl FOUNDA]LON_ NEAREST LOT LINE
NUMBER OF LINES__ ./~'-~ DISTANCE BETWEEN LINES _ TRENCH WIDTH
ABSORP.~N~AREA___ SQ. FT. LENGTH CE EACH LINE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEA1H TILE
IN, ABOVE TILE
WELL:
LOT LINE
TYPE ~,~..Z//.z.c~' , DEPTH -~ / DISTANCE FROM
, BUILDING FOUNDA11ON._.~
/~ ~/_ NEAREST /~= ~EP-T~G/~/~/; SEEPAGE
, SEWER LINE /~ , TANK_ ~ / , SYSTEM.~
WATER
_SAMPLE ,,,,-~4'/~-' , NEAREST
OTHER
, CESSPOOL//'-'/-~/-~c~'- , SOURCES~.~'?~
DISTANCES:
GIRE]/ ,IR /\NCI-IOtRA~2~IZ /:XlRI£/\ Be.q-, LJ(;H
;~.:w~,,~: bi§PO§AL SYSTEM ~- ^PPLICATION AND PERMIT
2192
DRAIN FIELD
DRAIN FIELD
.. SEEPAGE PIT
,, DRAIN FIELD
AUTHORITY
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
/~.' ':. ~,' ~
SEEPAGE PIT /~'" -, DRAIN FIELD , OTHER,
NO'I"JEI THIS PERMIT 18. NOT VALID WITHOUT SOIL TES.T
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANI~ SIZE ~ {~' ~/I~'?/'/~ TYPE /4~'"' GE AREA SIZE ,//*~;~' ' TYPE
MINIMUM DISTANCES', REQUIREMENTS' ! DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE,
WELL TO SEPTIC TANK ~ \
SEPTIC TANK, /'~..2 ~' ., SEEPAGE Pit
., I; DRAIN FIELD
o
SEEPAGE PET /O
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT /D
GRAVEL BACKFILL
h BALTH~oURLi~ORiTy
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
/ 7
i~o
7°
10o
( ::~ o )
NOTICE
JAMES HAMPTON PARCEL and SI{EILA LEIGH PARCEL, husband
and wife, owners of the following described real estate:
Lot Nine (9), Block One (1), of THE LANDINGS
SUBDIVISION, as recorded in the Anchorage
Recording District, Third Judicial District,
Alaska,
hereby give notice that the single family dwelling house lo-
cared upon said lot is served by a sewage holding tank, that
said holding tank was only allowed by'special dispensation
of the Greater Anchorage Area Borough by action on the 19th
day of June, 3.972 and that said property must be solely served
by said holding tank until municipal
THIRD
O~LASKA )
)
JUDICIAL DISTRICT )
DATED this ~ day of June,
sewer is available.
1972.
SHEILA LE:~N' 'PARCEL
SS.
THIS IS TO CERTIFY that on this ~d? day of June,
1972., before me, the undersigned, a Notary ~ublic in and for
A!as!~a, personally appeared JAMES HAMPTON PARCEL, known to me
and to me known to be 'the individual who is named in and executed
th.e foregoing instrument and acknowledged to me that he signed th~
sa~e.freely and voluntarily for the intents and purposes therein
set forth.
WITNESS my hand and official seal the~day and year
N~TARY PUBLIC in and for
My Commission Expires- / z
STAT OF
THIRD JUDICI~ DISTRICT )
THIS IS TO CERTIFY that on this ~ day of June,
1972, before me, the undersigned, a Notary Public in and for
Alaska, personally appeared SHEILA LEIGH PARCEL, known to me
and".to me known to be the individual who is named in and executed
th9 foregoing instrument and acknowledged to me that she signed
the Dame freely and voluntarily for the intents and purposes
't~e~in set forth.
' ' WITNESS my hand and official seal th~9 day and year
/~OTARY PUB~IC'in ~nd for A~asJ<~
Submitted by.'
Environmental qual i t~
GREATER ANCHORAGE AREA BOROUGH 'i~' ;
Assembly Memorandum No. 72-345
To: Borough Assembly
June 19, 1972
From: Borough Chairman
Subject: Appearance Request by James Parcel in Reference to
.Landings Subdivision, Lot 9, Block 1, Denial of On.-
Site Waste Disposal Permit
On June 12, 1972, Mr. James Parcel applied to the Department
of Environmental Quality for a permit to install an on-site
waste disposal system. That permit was approved pending the
results of soils tests to be
soils test was performed and
(clay, silt mix) which precl
waste disposal facilities in
State law. Consequently, th
was denied.
performed on the property. The
brought forth soils conditions
uded the installation of on-site
accordance with both Borough and
e on-site waste disposal permit
Mr. Parcel then asked for approval to install a holding tank.
(A holding tank is a steel or concrete tank into which all of
the household wastes are discharged and accumulated until they
are pumped by a sewage pumping truck and hauled to a Borough
sewer hanhole where they are discharged.) Approval of a hold-
ing tank was denied under the guidelines of D.E.Q. memorandum,
Subject: Standard Operating Procedures for the Use of Sewage
Holding Tank, dated December 22, 1971. A copy of this memor-
andum is attached for your info~mation.
The D.E.Q. Department memorandum was developed because of ser-
ious problems that the Department has experienced in the use of
holding tanks. At one time, there were more than 300 holding
tanks in use within the Anchorage Borough. Now there are less o
than 40. The Department discourages the use of holding tanks
for other than short term use or where a publi.c health hazard
exists because of the long history of problems that we have
experienced in administering and surveying holding tank systems.
In this particular case, public sewers are some ten years away
from the parcel of land involved. A holding tank, if approved,
would require pumping every five to seven days at a cost of ap-
proximately $20.00 per pumping. Over a ten year period, if no
price increases occur and the family using the residence does
not grow and the water consumption habits of the family living
in the dwelling result in minimal water use, the cost of oprr-
ating the system would be. approximately $12,000.
Assembly Memorandum No.
June 19, 1972
Page Two
72-345
Our experience over the last five or six years using holding
tanks has shown that in the vast majority of cases the pro-
perty owner involved soon decides to seek other alternatives
rather than paying this high maintenance cost such as the
owner sells the property, telling the buyer only that the
property has a Borough approved sewage system not that it
is a holding 'tank that requires pumping; or, the property
owner modifies the system so that the sewage is allowed to
discharge to 'the surface of the ground creating a potential
threat to the health of the public.
We have found it necessary to maintain a monthly surveillance
of all holding tank systems until they are replaced by public
sewers. The direct cost in salaries and vehicle mileage for
that surveillance will be $1,056. Again, assuming no cost
increase within the next ten years.
The Department of Environmental Quality has disapproved several
hundred holding 'tanks under the Department policy memorandum
since December of 1971.
IT IS THE RECOMMENDATION OF TUE ADMINISTRATION THAT THE BOROUGH
ASSEMBLY TAKE NO ACTION CONCERNING THE DENIAL OF MR. PARCEL'S
REQUEST FOR APPROVAL OF A HOLDING TANK FOR A DWELLING UNIT TO
BE LOCATED ON LOT 9, BLOCK 1, LANDINGS SUBDIVISION.
JMA:CPJ :rn
e~lc,
Respectfully submitted,
~~M. Asplund '~
~orough Chairman
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
MEMORANDUM
,December 22, 1971
TO: Environmental Services Section
FROM: C.P. J u d k Sn~-~-, -~, S.
Direc<~ ~! [~,;x./)
' SUBJECT: Stan~]-ar~d Operating Procedures
Monitoring of Sewage Holding
for the
Tanks
Use and
The Department of Environmental Quality has, in the past, allowed
sewage holding tanks to be used to satisfy special needs and con-
ditions.
The demand for such 'Facilities has grown considerably over the
past few years. Today, we have some 42 holding tanks in use.
Holding tanks are not a satisfactory method of was. re handling on
a long-term basis because of the continued surveillance required
to insure that they are properly serviced and because of the 'tend-
ency, on the part of some people, to sell houses with holding tanks
without making the buyer clearly aware of what he is buying,
In order that the use of holding tanks may be kept at a minimum,
the following policy is placed iDto effect immediately.
USE OF SEWAGE HOLDING TANKS
Sewage holding tanks will be allowed within the Greater Anchorage
Area Borough by special permit only and under the following condi-
tions:
1. Existing dwelling units or businesses:
Ae
.Where an existing sewage disposal sys'tem has failed
and.cannot be replaced or rebuilt due to high water
table, tight soil conditions or other conditions which
would create a danger to the health of the public.
The above is subject to an all year access road being
provided and the tank sized to provide a minimum of
five (5) days holding capacity based upon one hundred
(lO0) gallons per person per day.
Use of Sewage
Dec. 22, 1971
Page Two
g Tanks
New dwelling unit or business:
A. The Department will discourage the use
tanks for il·V/ construction;
of holding
Holding tanks for new construction may be.allowed
under the following conditions:
Where a contract for construction of a public
sewer system has been let with a completion
date of less than ninety (90) days from the
date of the holding tank permit and tile Public
Works Department has issued a statement insur-
ing that the public sewer line ~.~ill be avail-
able for connection prior to the termination
of the ninety (90) day period.
II.
Where sufficient funds, as determined by the
Department, have been escrowed or otherwise
provided to pay the cost of connecting the
facility to the public sewer system.
Witl~in watersheds of the Greater Anchorage Area Borough
as required by G.A.A.B. Ordinance 28-68. ,
Under other conditions where, in the opinion of tile Director,
a holding tank is necessary to protect the health of the
public.
· um~s~fs to ~nle~ pu~ ,¢1!leOal ~cll o~ Ou!l~ll~
:'lVSOdSlO ~/VA~3/$VA~ dO IdA/ 't~
'uJe~s/(e ]o sn,~.~s pue /fuIeBel eq~. o~ Bu!
-.~$e.~.le OBQV e?,E~S uJoJj uo!.leu, u!Juoo ue.~/.J,~ eplAoJd '~e~,s,,fs Ile,'~ /Q,!unuJuJoo ]1
/~',PZ.- 6A S euoqd XeO.
Je~e~ o!lqnd
Ile~ x~!unwwoo
Ile~ lenp!A!pul
:3/ON
:A'lddnS ~I~U.V~ JO ~dAJ. '1~
:smo°aa aa OaaamnN '¢
euoqd XeO 't/'N XoueSe 8u!pue-I
.,,/ oO l ','~ I IL ~. sseJppe 8U!l!elAI
I/~/I- £A, ~. euoqd X~Q /~2.~g ~.¢ ~/', JeuMo XuedoJd
'¢-/~'7' uo!~d!Josep lel~el e~eldLUoO
: NOIIVINI:IO4NI'IVI~tN~!9 '~
STATEMENT OF INSPECTION ElY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation Of this Health Author!ty Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, Junctional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my ipvesUgation and inspection, the on-site water
supply and/or wastewater d~sP0sa! system ~s in. compliance With all Municipal and State codes,
ordinances, and regulations in effect on the date Of this inspection.
DHHS SIGNATURE
Phone
Date
A~)~;oved for' bedroomS.
Disapproved. ·
Conditional approval for Y 'bedrooms, with the following stipulations:
AdditiOnal comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph' 5 above by an independent
professional engineer registered In the State of Alaska. The DH HS does this as a courtesy tQ purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements, Employees of DHHS do not
conduct inspections or aha yze data before a certificate is Issued, The Mun c pa ty of Anchorage s not
responsible for errors or omissions in the professional engineer's work, '
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: J~ ¢/ /~ ./.., 'T'~¢" ~¢(/') ¢~/'nq¢'..c _ Parcel I.D.
A, WELL DATA
Well type
Log present (Y/N) ./~
Total depth _ ~' .,~O '
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter,
Date completed
Cased to_ ¢ .~O'
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
,~t~/holding tank on lot
Absorption field on
Public sewer main
ADEC water system number _ N,4-,
19 7 ?- Driller t4 ~¢'
Casing height h¢ Cf
Wires properly protected (Y/N)
AT INSPECTION
II / 15'/ '~/
i~'
o~
__; On adjacent hots '~. too '
; On adjacent hots ~, foo'
Public sewer manhole/cleanout
Public sewer service line
__ Petroleum tank
WATER SAMPLE RESULTS:
Coliform 42 ~o~
Date of sample:
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed '7 /5-/' 7 ~ Tank size ~ / ~¢2 k~,¢ ! Compartments /
Cleanouts (Y/N) ~ Foundation cleanout (Y/N) N Depression (Y/N)
High wateralarm (Y~_~ To lae ,~$/-. Gy 0~/~5'/¢/~ _Alarm tested (Y(~ 'To ~ re.c/; ,~),
Dateofpumping ~¢' /~$-/¢/I ~/v ~(¢/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)on lot ~'~' ~rof,, ¢, ¢,, On adjacent lots
To property line .,3¢ ~ Absorption field
Surface water/drainage ~. (
_Foundation I
Watermain/service line _'~
72-026 (Rev. 3/91) Front MOA 21 CONTINU ED ON BACK PAGE
C. LIFT STATION /~,
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Width
On adjacent lots
Well on lot
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Manufacturer
Manhole/Access (Y/N)
~ "Pump off" level at
Cycles tested
Surface water
Soil rating
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
for
If yes, give date
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots Property line
To existing or abandoned system on lot
Cutbank Water main/service line
Driveway, parking/vehicle storage area
Engineer's Name
Date
System type
Total depth
bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
Signature
Waiver Fee: $
HAA Fee $ //'7~)
Date of Payment
Receipt Number
72-026 (Rev, 3/91) Back MOA 21
Date of Payment
Receipt Number
//,t,C~}~i~,~,~,~',',~ , DEPAIR1HEt' OF H~{AL]'It AND ENVI RONt'.1ENT PROTI:CTION
l)aLc _! ~_].~ - ~ ~_~(.~.o DaLe ................. DaLe ..........
APPROVAL O1_'' IND] V I:IPUA]b SEWiqR AND WA'I?ER [PA(. I ]Z,l.} II:l-}
[,ending ]'nst~h]Li_on Nequ. esL:
% Mary Ann Dodge
Firs% National Bank of Anchorage
]?roperLy Owner: James H./Sheila L. Parcel. l_qmmc: 276-5212/Mrs.
Mailiug Ad,zlress: Star Route A Box 4004P 99507
3.
4:
Lc!gal. Descript:.iofl: :Lot 9 [flock 1 The Landings subdivision
,Sh~gtc' Family Ros:idcmce: ~
Family Residence:
Numboc o [ 3odi:'£)o!lls:
Well System: lndJ.vidua'l. W,~.l_]. (xx/ Community/Pt]blJ(: >h,s{.cm ( )
Permi. t. ~1 Dephh caf Well We}.} Log m Fi} :~
txm, t ]. uc L LOll Bec hc~:'ial Aha I y s ts
6. Sewage
,J t: .t..I. ] t. y
Perm-i_L t,t [lisiall,:td '7~'~-Y'~-- ~nsta.llct'
Absorption Area "~-~-~-- ....... 7-'-- Sci].s Rate ..................
D:i. statnces: Well to F~c Ta~( __~_0 ............ tie Absot:puAon Area
Sewer I,Jne Nearest Lot line ................... Absorption Area
to Nearest .I,oL ]SLnC
MUNICIPALITY OF ANCHOFIAGF
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99~04 276-2221
REO. UEST FOR APPROVAL. OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address: Sl~ Box 4004P
3. Name of Buyer: None
Mailing Address:.
4. Name of Lending Institution:
Mailing Address: P.O. Box 720
5. Name of Realtor or Agent:_
Mailing Address:
6. Legal Description:
Location:.
CMRO VA
James H. and Sheila L. Parcel
FHA CONV. X
Day Phone: 276-5212 (Mrs. Parcel)
Day Phone:_
First Nat:. Bank of Anchorage
Anch.~ Ak.995]~lone:_ 276.-6300 x572
Lot 9, Blk 1 Landings S/D
NHN Old Seward Nighway
Phone:_
7. Type of Facility to be Inspected: SFR
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well.
9. Sewage Disposal System
Type of System: Public Utility.
If Individual, date of installation
No. Bdrms. 2
,Individual. Well
Individual (on-site)_ Septic
Mary Ann Dodge, Real Estate
12/5/77
72-003(3/76)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~_~/~/
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by: ~/~//~ .~C~ZJ
Mailing Address: _ hone:
2. Property Owner: ~¢~[£~ Phone:
Mailing Address: .~//~
5. Type of facility to . '----~
6. Well Data:
C. Const uct' ~ ~ D. Bacterial Analysis
7. Sewage'Qisposal System:
C. ScF~/Tank: 1. Size ~/~z~.~ 2. Manufacturer
D. Seepage Pit: 1. Absorption Area ~ 2. Material
E. Disposal Field: Total length of lines ~
Distances:
A. Well to: ~ptie tank 7~/ , Absorption area
Nearest lot line /~ ! , Other contamination
B. Foundation ~u-~ep~ tank , Absorption area
C. Absorption area to nearest lot line __-2~z~
, Sewer Lines /~z ~
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re.,.sst for Approval of Individual . ~er & Water Facilities
Lo. gal Description __~<'~_-~_-x~.._~_t~_ ~//~//z~°f~~
Approved
~.~<~' _~_~-~)Disapproved Date ~z
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-.034 (1/7q)
Greater Anchorage Area Borough Assembly
Attn: Borough Clerk
June 13~ 1972
Dear
I wish Ko be heard_.at ~l:he~nes~. regular Assembly m~mting regarding a sewer sy~tem
prob/~em'q~h Land£nss Subd~v~sion. ~
J~e8 H, Parcel
3300 Brookside Dr~ve
Anchorage, Alaska
279 6904
PLAN REVIEW FOR BUILDING PEIhMIT
GILEATi£R ANL]IORAGE AREA BOROUGH
D~ te )f Review
DESCRIPTION OF LAND USE
( )New Structure ( )Addition ( )Alteration
( )New Use ( )Change in Use ( )Other
Speci fy.
Present Use of Land
Present Use of Structure
USE OF STRUCTURE
A. Residential: ( )Number of Bnits
Accessory: ( )Soeci fy
B. Co~erci al
C, Industrial: ( )
D. Other: (
NEW STRUCTURE
A. Height Stories.._
B. Existing Building Area_ SO. FT.
C. Proposed/Additional
Building Area SQ, FT,
D. Total Building Area SO. I-[.
E, Nun~er of Principal Rooms
F. Type of Water System
G, Type of Sewer System
H. Estimated Value of Constructien $
I, Estimated Date of Completion.
J. Other
COMMENTS:
DO NOT WRITE IN THIS SPACE
)ate Received
Zoning District
Planning I)istrict__-_-_-_-_-_-_-_-_-~_7~f--~--fire Zone
Special Exceotion Approved
Da te
Variance Approved
Da te
Note: Attach Case Minutes to this form
CHECK FOR COMPLIANCE
Lot: Area ~d~
Yards: Front (~_)~.ide
Building Height (~l-~}ns (~.~
No. of Parking
REVIEW
Public Works
Ri ght-oF-Way
Environmental Quality
Fire Marshall
DISPOSITION
Insufficient Info. Field Clleck.
Approved ( ) Date
Issued ( ) Date Permit No.~_
Denied ~.~' Da te
/
o~
BUILDING PERMIT
BUILDING SAFETY DIVISION No.
O ['LAN NO.
~500 TUDOR ~OAD PHONI~ 2?9 8686
LOT ((~ J ~/J)' /] /' ' "") ZONING FIF~E
RESIDENTfAL ¢, ,~/~U'tEX LJ .... [.~] ' STRUCTURAL
ELECTRICAL
P~UMBING
COMM~NCF 'DY LqY~
POST IN CON PICUOUS PLACE
ALL WORK MUS' BE INSPECTED
A A4 HOUR NOTICE IS REQUIRED FOR INSPECTION SERVICE
/:4 ~,~.d
