HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 2- 014 O-/I
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· . INSPECTION APPOINTMENTS ~
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MUNICIPALITY OF ANCHORAGE ~EPT. O~ H-ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION J~J~O~ENTAL
825 L Strut · Anchor~, AI~i ~1
( ) ENVIRONMENTALSANITATION DIVISION AU~ 2 2 1980
T~e~e ~47~
BI RECTIONS: Complete all pa~s on page 1. I~omplete r~u~= wiB not ~ pr~. Please allow ten (10) days for pr~sing.
PROPERTY RESIDENT (If diflerenl from 8bow) ~HONE
2. BUYER PHONE
MAILING AOOR E~S
MAILING ADDRESS
4, REALTOR/AGENT I PHONE
I
MAILING ADDRESS
5, LEGAL DESCRIPTION
STREET LOCATION '
6. TYPE OF RESIDENCE NUMBER OFtBEDROOMS
V {~ SINGLE FAMILY ~ I--I One [-I Four [] Other
//' [] Two [] Five
[] MULTIPLE FAMILY [~ Three [] Six
SUPPLY ~-// ~' -- 3-~ t
7. WATE~ INDI'VIDUAL* ,,~r* AT[ACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY ~/;///~' ° (~ ' since June1975. For wells drilied prior to that date, glvewell
I-'1 PUBLIC UTILITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE"* YEAR ON-SITE SYSTEM WAS INSTALLED.
~ PUBLIC UTILITY
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. TY[~E OF RESIDENCE NUMBER OF BEDROOMS
r-] SINGLE FAMILY [] ONE [-I THREE i--I FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
:)ATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE , DATE iNSTALLED
•PUBLIC UTILITY
Connection Verified .c~-~T~ INSTALLER
i-]Septic Tank or [] Holding Tank
Size: If Tank is homemade SO~LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holdm0 TankIIAbs°rmi°n AreaIlsew~r Line
I Nearest Lot Line
I
Absorption Area to nearest Lot Line
5. COMMENTS
[~.,'~PP ROV ED FOR ~'-~ ~BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[--I DISAPPROVED
DATE BY
'/2.010 (Rev. 6/?9)