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Home My WebLink AboutSMITHWAY Block D Lot 4-Dis Mt Time APPLIC NT FILLS OUT UPPER HAL_,_, ONLY Time Property owner !1 Vf, Phone ry Date ., s0-�ip Code Ma7ing Address . _ uyer Inspector Address Zip Code Lending Institution Inspector Phone Address Zip Code ( -APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Realty Co. & Agent - Phone Address Zip Code Septic Tank Size Legal Description Lot 4D Block D Smithway_ Subdivision Street Location 1006 West 39th Avenue 99503 Type of Residence ❑ Single Family - Multiple Family No. of Bedrooms - - - ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. /� ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal ❑ Individual Year Individual Installed: Public Utility When Connected to Public Utility:�.�' Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. - Time Time Time Time - Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: 7 /� .. I/ — G,d/ ( -APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed - Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72-023 (3182) +MUNICIPALITY OF ANCHORAGE - STREET LOCATIONq 1 b � w, ( rl MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 8 6. TYPE OF RESIDENCE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT[CMVIRONMENTAL PROTECTI N 825 L Street - Anchorage, Alaska 99501 l� • q OCT 1 2 19 ❑ SINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION MULTIPLE FAMILY Telephone 264-4720 R E C E �% P CIL�I`II REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAIg DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. - 1. PROPERTYOWNER L iO 01) ;S c(�acto2 �@ PHONE �'7��or � MAI LING ADDRESS 7 I W c3 PROPERTY RESIDENT (If different from above) PHONE. 2. BUYER by this Department. PHONE 7 ey M ILING ADDRESS S / 3. LENDING INSTITUTION &t A 5'" w-' S• A - Q4tf-Dj - (Wrok) PHONE 0'V-91:5 MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION �o t6cr, D. ` e r 15w) �� 15vwl olslaz STREET LOCATIONq 1 b � w, ( rl 6. TYPE OF RESIDENCE NUMBER OF EDROOMS ED One %X Four ❑ Other ❑ SINGLE FAMILY ED Two c«c 0000 ❑ Five MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY °`i'y`(:' INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled-orior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - --- - ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date. PUBLIC UTILITY If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACC PANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) 1471-V THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ' ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE El PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS APPROVED FOR BE RO S ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE //r • AQ r1 IV BY (Title) [LEGAL DESCRIPTION 72-010 (Rev. 3/78)