HomeMy WebLinkAboutWONDER PARK #1 BLK 5 LT 10
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Date
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~UNICIPALITY OF ANCHORAGE
DEPAR'FMEN, OF Ht~ALTH AND FNVIRONMENT$,
825 L Street, Anchorage, Alaska
279-2511, ext. 224 or 225
PROI'ECTION
99!301
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Time
Date
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Date Received:
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Date
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REQUEST FOR At~PROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. I,ending Institution Request: Lomas and Nettleton Company
Mailing Address: 4449 Business Park Boulevard
Phone: 274-7661
2. Property Owner: Vance Phone:
Mailing Address: 104 Stewart Street 99504
Legal Dc.crlptlon. Lot 10 Block 5 Wonder Park Subdivision
4: Single Family Residence: ~) Number (of BedroOms: Three
Mllltiple FamJ. ly Residence: ( ) Nmnber ef Bedrooms:
5. Well System: Individual Well ( ) Community/Public System
Permit # ~-. ................ Depth of Well ............. Well Log on File ( )
construction
Bacterial Analysis
6. Sewage Disposal System: On--site System ( ) Public Utility
Permit It In'stalled Installer
SeptJ. c Tank Size Manufactnrer
Absorption Area Soils Rate Material
7~ Distances: Well to Septic Tank to Absorption Area
te Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Depari:ment of IIealth and Environmental Protection
Reques~ for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 10 Block 5 Wonder Park Subdivision
Affadavit Attached: ( ) Letter Att:ached: ( )
Approved: DaP. e:
Disapproved, C~r~-j~ ~'-.-'~ '~Q ,,.~ Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279--25]_1, ext. 224, 225
REQUEST FOR APPROVAl. OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
~./
2. Property Owner: ~/~_t~¢~ .
VA_~'__ _F-A ....... CONV
Mailing Address:
3. Name of B.ye,':
_ Day Phone: ...........
Mailing Address:_ ,z///,~,~¢¢. /'~¢¢,_..,~,¢.~/~ ///~.~/J-O7
Day
Mailing Address: .. Phone:
Type of Facility to be Inspected:___~_
Water Supply
Type of Supply: Public Utility
No. Bdrms.~.
Individual
If Individual, number of dwellings presently served __
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
Individual (on-site)
If individual, date of installation
72-003(3/76)