HomeMy WebLinkAboutTURNAGAIN WEST BLK 2 LT 7
DATE RECEIVED
APPOINTMENTS
INSPECTION I f'~/ ~/
TIME TIME TIME
DATE DATE ~' ~ DATE
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
( JUL 9 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720. RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four [] Other
[;~;~1N G L E FAMILY [] Two [] Five
[] MULTIPLE FAMILY [~"'~:~ree [] Six
7, WATER SUPPLY ~O_ _~ ~1
[] INDIVIDUAL* ~'-~'_~-'~ *ATTACHWEL~LOG. AwelIIogisrequired for all wells drilled
[] COMMUNITY -- ~ Lcc, nce June 1975, For wells drilled prior to that date, give well
[~]~/~I~UB LIC UTI LITY ~ O ~ depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
I~'~"PUB LIC UTI LITY
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 NUME~ER OF BEDROOMS
ONE [~ HREE [] FIVE [] OTHER
E} MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[~] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[~] PUB LIC UTILITY
Connection Verified
INSTALLER
[]Septic Tank or [~] Holding Tank
Size: If Tank is homemade SOl LS 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
5. COMMENTS
[}~'"~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~//,~
72 OIO (Rev. 6/79)