HomeMy WebLinkAboutYALE BLK 2 LT 6
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.030 Street, A~c~cmage~ A'lasl~ 9~)5(}3 274..456]
Date Received
/ ~ I"ime of' lnspectio,-,
REQUEST FOR JiPI~OVAL OF
INDIVIDUAL .~E. Wxi~ & WAFER f-~{ h 1l.
FOR .,
//I .' .~(.. 'x v. . /' , '-/ '. ..~ /
1. Approva] req rested by: /.C,., v' ~ ,, ,-. . ~
Ma~ling Addr'ess: ..... ) ~'~' ~ '~ .... :) ' Phone:
......................................................................
2, Property Owner: [( , --~ it, q .¥ ~
Mailing Address: ~ ~.. ~ ]'-'~, . --
Legal DcscripNor. ~ /. ~- ~ ', : ~ ~- )
........................... =: ............ :';:t ...... x_- - t · :.
Location: I- /u',,~:r',~ i ~'~ (~
Type of facility to be inspected-.-~./]~.?~c~:/~:. ............ f'k). oF bedroonJS
'Well Data: C[_Jbj~'n2, uc~ ~%~-~ (~ ~.l--~ t: '5 I~ (
k
A, Type ~( ......................... , B.
C. ,o,ls'{Y'UCt]on D. ~a,''~' ";,'
.... .r ,~1 lysis
................................. ~h~d .
Sewage Disposal System: /~' } ~Ft.'~ ' ~', ~ i~ ~,
A. Installed B, Installer
C. Septic Tank: 1 Size 2. ''"
D. Seepage Pit: 1. Absorption Area 2. MaLer'ial
E, Disposal Field: Total length of' lines
' pti ' , -' .-
A, ~ell to: Se c tank ......... , x,)sorptlo, ....
............ , Sewer Lines
Nearest lot line , OLher corlt~.'min~Lion ..........................................
B, Foundation to septic tank ............ ~ AbsorDt:io~ area
C, Absorption area to nearest 'lot line
EQ-.034 (1/74) Page I oF two pages
t~[)i)ro,/e(l ' ~. ~ f * , ': , ¢' k ' '~'~ ' ed ' Date .%"( / q
///.' ~:'~.'l ( /~pn'tuv, "sl',d for one ye r from da~e sit, ned
(~;,~. ~ t~)~.nc~K~-~?~',;:; ~,.~.or~:~gn, Depardnent o'r t:nvlronmental Quality
//
u- I)!AGIW,~ OF SYS1 EM
certify tr, a[- ~i?; 1~ r~;,][",':, ':oY:L~:~r, el In this request for approval to be a true and
accurate rerme~,c,,~ation of L~ :,.~ :~-t ' '~,
u.,.,.~ sewer and water 'Facilities and tn:se
are opeYat~ ng 'TM"..... ' ~.7
,o,lS~dC~. F1 , ,.
S 6..mb Date
EQ--D34 (i/74)
GREATER ANCHORAGE AREA BOROUGH
3500 EAST TUDOR RD. ANCHORAGE, AK 99507
PHONE: BILLING 279.0541 SERVICE: 279-4771
ACCOUNT NUMBER CYCLE BILLING BATE
01122320-00100 1 10-01-75
EXPLANATION AMOUNT
~s ~o~ o~ NOV',
% DEc. :{2.95
FSR PXERIOD ENDING TOTAL DUE:
12-31-75 $22095
FOR SEWER SERVICE AT
9321 ~
PLEASe': PAY WITHIN 20 DAYS OF BILLING DATE
GREATER ANCHORAGE AREA BOROUGH
3500 EAST TUDOR RD. ANCHORAGE, AK 99507
PHONE: BILUNG 279-054! SER¥1CE: 279-4771
01122320-00100 1 01-01-76
CURRENT CHAR~E:5::;,,.a: 22.95
03-~1-76 $22,95
g321 ENERALE
