HomeMy WebLinkAboutURBANEK KERKOVE LT 13BK
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APPLIC NT FILLS OUT UPPER HAl ONLY
Property Owner ~'~
hoV l.
Phone
Mailing ,~ddress Zip Code
Lending Institution
Zip Code
Address Zip Code
Realty Co & Agent
Address
Legal Description
Type of Residence
Single Family ct Bedrooms _ ~..'~
. Multiple Family NO. ..
~ Other
Phone
Phone
.~
Water Supply ~ /
_~. Individual ATTACH WELL LOG. A well Icg is requited for all wells drilled since June 1975.
~] Community :N' '/' For wells drilled prior to that date, give well depth (attach Icg if available),
[~ Public Utility
Individual ' , · , i , f ~ I ~' ¢ '-" ~ ~' '(~ '~' Year Individual Installed:
Public Utility When Connected to Public Utility:
Time Time
Date Date
Inspector Inspector
Field
Date
Inspector
Time
*CONDITIONS OF APPROVAL
MUtqJCIPALiTY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONM[NTAL pRoTECTION
( )DISAPPROVED if monies are escrowed to have the property
Xi>~CONDIT[ONALAPPROVAL'~ connected to the public sewer. Verification
D~_.~¢~C'/~"~,~j giv~~ffice after connection has
been
0 ~ mS89O57~24.E:
'TUDOR
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26&91 Comp
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296Z6 Gom~
1632
t~96.84 Comp
~96.92 ,Comp
EAST ",~ "-
TO
o
SIGNED
REPLY
~T~,~ 4S 472
SIGNED
SEND PARTS 1 AND 3 WITH CARBON INTACT -
PART 3 WILL BE RETURNED WITH REPLY.
DETACH AND FILE FOR FOLLOW-UP
DATE
/ ,/
Excavation & Paving Co.
BO× 2281
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