HomeMy WebLinkAboutJEWEL LAKE TERRACE LT 1
APPLI(....,NT FILLS OUT UPt.'~H
~- Phone
Re~lt~ Co. & Agent ] Phone
~/A Zip Code
Address
Type of Reliance
~Single Family
~ 'Multiple Family No. of Bed[ooms
~ Other
~ Individual ~-Z ~///~ ' ~y~' '~ A~ACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
icg if available}.
G Community '~ ~
~Public Utility <~.~ ~ For wells drilled prior to that date, give well depth (attach
~dividual .~ ~ ~ ~ .- ~ ~ ~ ~ Year Individual Installed:
'~ Public Utility ~'t~>~ ~i~1 ~ ~/.~ ~ ~ When Connected to Public Utility: ~ ~ ~ J '
~' Holding ~ank ~ '/ / / ' ~
NOTE: THE INSPECTION FEE MUST AccOMPANY EACH RE~E~T BEFORE ~OCESSIN~N BE INITIATED,
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH g~
ENVIRONMENTAL PROTECTION
JUN 3 0 1983
RECEIVED
(~,~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
I } D~SAPFROVED
< } COND,T~ON~LAPPBOVAL'
DATE ~,./~.~,/,~,'..,.t ,-'"2
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
I
72-023