HomeMy WebLinkAboutTURPIN BLK 2 LT 29
The ~unieipaltty Of Auehm, a~ Det~el~t o~ Vublle ~s h~
RECEIPT FOR CERTIFIED MAIL--30c (plus postage)
POSTMARK
SENT TO OR DATE
TREET AND NO,
P,O. STATE AND ZIF CODE
RETURN ' With delivery to addressee only ............ 65¢
RECE PT · 2 Shews to whom, date and where~adelivered.. 35~
~ ' With delivery to addres~~--
SERVICES
~ECI~V~Y (extra fee requ,red) .............. ~; ...........
PS Form 3800
Apr. 1971
INSURANCE COVERAGE FflOVIOED-- (See
NOT FOR INTERNATIONAL MAIL * G~o:~
GREATER A~RAGE AREA BOROUGH
FE rEST
Owner:
///·
Mailing Address:
User / Tenant:
Propertx Address:
Subdivision:
TES T:
[] Pos/give
i~' Negative
1.~e following service is requested (check one):
[~ Show to whom and date delivered ............ 1§~
[] Show to whom, date, & address of delivery..
[] KESTAICTED DELIVERY.
Show to whom and date delivered .............
[] i~ESTRICTED DELIVERY.
Show to whom, date, and a~dress of delive~
~eresa ~amondon JK/lw
6531 E. 9th Ave.
Anch., Ak. 99504
740257
have received the a~icle de<fibed above.
SIGNORE ~ Addressee ~ Authorized agent
. ,. .
6. UNABLE TO DELIVER BECAUSE:'
F/eld:
Adm/n/sfered By:
REQUEST FOR APPROVAL OF /
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Name .of person requesting approval ·
N m .-o , ,droome in house '
a. Bactemi~_l..
b. Detergent
6. Well data:
al Type.. ~
b. Depth__ '
c. Casing Size~...
d. Distance from well ~ closest existing or proposed:
1. Sewer line
2. Septic tank
' . 3. Seepage Area
/' 4. Cesspool_~
~,~ ~ f- 5. Property Line
, 0~b~ ~VL
~ ~;~/ //) 6. Other sources of ~oss ble contamination, i.e., creeks, lakes,
~ ~,~ ~., ~ houses~ barn, drainage ditch, etc.
' a. Age of system ....~
.f~ ~. b. Septic tank capacity in ~,~ns
c. Name of septic tank manufactu~,
1. If "home made" show diagram on reverse side of this form,
Disposal field or seepage pit size and type
1. Distance to property line to house foundation