HomeMy WebLinkAboutUS SURVEY 3042 Lt 97A Plat# 87-146 S-8607
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division 7n/z-'¢ ./~' ......
CASE REVIEW WORKSHEET
CASE NUMBER: DATE RECEIVED: COMMENTS DUE BY:
S-8607 February 23, 1987 March 16, 1987
SUBDIVISION OR PROJECT TITLE:
Lot 4A Tony Schaffe Subdivision & Lot 97A USS #3042
With Vacation
( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE
( ) COMMUNITY WATER AVAILABLE
71-014 (Rev. 5/83)
WATER & WASTEWATER UTILITY
3000 ARCTIC BOULEVARD
PHONE 786-5557
CONNECT PER /iET
DATE OF APPLICATION '" / -- /' ':'~ r/
SCHEDULED COMPLETION DATE
, ~/SINGLE FAMILY
U MULTI-DWELLING
No. APTS
LJ COMMERCIAL
TAXCODE O~¢_~3--J~ .GRID '- ,', AS-BUILTNo
ASSESSMENTS ,
El Main oxlension agreement
L] Improvement District
[] Extend conRect agreement
171 Pending
[] MAIN TAP--TO PROPERTY LINE ONLY
(MOA or Stale ROW Permit Required)
[] MAIN TAP & ON PROPERTY CONNECT
{MOA or Stale ROW Permit Required)
.~, R~O-W NOr
CONNECTION SIZE_ ('t
. CHARGE
iNSPECTION .FEE
PERMIT_. --FEE
REIMBURSIBLE
NUMBER . DEPOSIT $~__
TOTAL $ / '
PE~~y:
E] PAID [3C~H
iNSPECTED BY:
REMARKS:
MAIL ADDRESS _
HAVE READ THE COhlDITIONS AND REGULATIONS ON THE REVERSE SIDE OF 1HIS PERMIT AND AGREE
TO COMPLY WlT~-I THEM
POST IN A CONSPICUOUS PLACE AT THE J-OB SITE
AWWU INSPECTOR