HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 6 LT 19
PROTECTION
9950].
DaLe Receiwed: June 24, 1977
#l: Time 11:00 a.m. ~2: Time ~3: Time
Date ._6_ U 2~i.'~! _7._Mo_n_d a y
Date Da Ee
Insp Willis Iasp / Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lend i.ng Institution Requesu: ___A._laska_,_MpSBiLl_._Sa_v__in_g_s_ Baj!k
Mailing Address: _p_~__s.t._~0ff_i_c_eBp_~{_ll_~2__0- ............... Phone
Property Owner: __ ~.t_..qp.~h.g.p_.~[rp_w.~n .......................... Phone: 349-'1968
Mai] ing Address: _~8_6_..ll~ppiter Dirve
3. I,ega] Description: Lgt_~_l__9_..~_l._oc~k__6_.._Zo_.d_~_a~_ Ma_n_or_S_u_b_di~v_.i..s_i~o_n_
Single Family Residence: (x) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
5, Well System: Individual We].]. (x) ¢.ommunlt. y/].ub]~c System (
Permit Depth of well Well Log on [ lle
Construction Bacterial Ana].y sis
( )
6. Sewage Disposal Syscom: On--si.to Sy.~uem ( )
Public Utility
Permit ,,~ Installed Install_er
Tank Size
Manufacturer
Absorpt4.on Area Soi]_s Rate
Material
7. DJ. sEances: Well uo Septic Tank
Sewer Line Nearest Lot line
to Neares~ Lot I, ino
t:o Absorption Area
Absorption Area
Page Two
Request
Depart:merit of Health and Environmental Protec%ion
for Approval of Individual Sewer and Walter FacilihJ.es
Legal Description: ]Lot 19 Block 6 Zodiak Manor Subdivision
C Oll]l¥1e ]'1 ts
Affadavit Attsched: ( ) Letter Attached: ( )
Approved:
Disapproved
Date
Department Worksheeu:
MUNICIPALIIY OF ANCHORAGE
Department of Health and EnvLronmental
825 L Street, Anchorage, Alaska 99501. ~,:'l~ NON
279-2511, ext. ~24, 225
uost for Approval of Ind~uidua~ Se~er and ~aCer
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
Phone:
Phone:
Ma/ling Address: ---'"~ .~-- - Phone:
-/
Rea 1 t or/Account-: -
M~3%i~l .in g Address
I,egal Description:
Phone
" /2 ::.".j- .,;:-L"/ /
Number of B~drooms:
) Number of Bedroems
Street Location:
Single Family Residence: ~-)'
Multiple Family Residence: (
Public/Cormnunity System
( )
( ) Public System
Water Supply: * Individual Well /[~-.~_)~[
Iff Individual Well, well depth ~
If Community System, name of system
Sewage Disposal System: On-site System
If On-site System, date of ~nsta].lation:
*NOTE:
3/77
?
A well log is required on ALL wells drilled s~nq~6/75. /