HomeMy WebLinkAboutSWISS AIRE LT 9
DA~ E RECEIVED
TIME
INSPECTION APPOINTMENTS
TIME
DATE
INSPECTOR
TIME
DATE
INSPECTOR
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
NOV :~ 5 1979
ENVIRONMENTAL SANITATION DIVISION
Tg,e.ho.e 26.- 72o R E C E 1 V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
31R ECTIONS: Complete all parts oil page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
MAI LI ~IG~/~ E'l [~l~ ESS
PROPERTY R ESI DENT (If different from above)
2. BUYER
MAILING ADDRESS
PHONE
PHONE
3. LENDING INSTITUTION J PHONE
MAILING ADDRESS
4. REALTOR/AGENT ONE
MAILING ADDRESS
LEGAL DESCRIPTION
;TREET LOCATION
TYPE OF RESIDENCE NUMBER OFtBEDROOMS
[] One ~ Four []
Other__
~~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7, WATER SUPPLY
[] INDIVl DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
~ COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] 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, TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3, SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
E~ PUBLIC UTILITY
Connection Verified
[]Septic Tank or E~Holding Ta~tk
Size: If Tank is homemade
give dimensions:
NUMRER OF BEDROOMS
[] ONE [] THREE [] FIVE E~ OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Septic/Holding Tank Line
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
Absorption Area Sewer Line Nearest Lot
5. COMMENTS
DATE
[~- APPROV ED FOR ~ BEDROOMS
[] CONDITIONAl_ APPROVAL (letter must accompany certificate)
[] DISAPPROVE[)
72-O10 (Rev, 6/79)