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HomeMy WebLinkAboutKING BLK 1 LT 6Onsite File #012-325-08 Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore St. m P.O. Box 196650 m Anchorage, AK 99507-6650 w wvvw.rnu.i <i.org/onsi_e m (907) 343-7904 Legal Address: i ° 'si `U "k t' t,' V is Subdivision ; 'A Block Lot h T R �s Section Lot On-site Water & Wastewater Program certified contractor performing the well decommissioning: - Name: ecommissioning .Name:`a;3' Signature Company: i� tf* i 7 r., '\u Well decommissioning date:` i Method of decommissioning: AMC 15:55.060L3 a. ❑ b. ❑ Location: Use the space below to provide a drawing of the property showing the following items; • North Arrow © Decommissioned well, • Other water wells on the property, • Two separate swing -tie distances for each well shown in the drawing, Note: The swing -tie distances shall be measured from either permanent structures of property corners. 1 ('` kti � L s C.