HomeMy WebLinkAboutNEWBY S-5453
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DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
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DATE
DATE
DATE
❑ Two ❑ Five
❑ MULTIPLE FAMILY
4-\_ -
INSPECTOR
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 8, ENVIRONMENTAL PROTECTIOVEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PI:OTECTION
ENVIRONMENTAL SANITATION DIVISION MAR J 1 1981
Telephone 264-4720
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REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SERfiGid1,, LLilD
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY WNER
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PHONE
MAILING ADDRESS
PROPER 7RESIQENT (If different from above) PHONE
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- - - - - PHONE - - - - - -
2. P� i ^ to 5 / //�
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MAILING ADDRESS
32- 30 `' C_ Sir z l S 5 3
PHONE
MAILING ADDRESS /� G�
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PHONE
4. REALTORIAGEN/T
P E
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MAILING ADDRESS
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72-010 (Rev. 6/79)
5. LEGAL DESCRIPTION
L ok) /A 1,14
31-1
STREET LOCATION
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6. TYPE OF RESIDENCE
NUMBER OF,BEDRO MS
5.4-1 ► ❑ One ❑ Four ❑ Other
❑ SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATERSUPPLY
INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
El 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)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEE~T
F~J PLATTING BOARD (-~ PLANNING & ZONING
'EASE NUMBER NAME
S-5453 Newby Subdivision
DATE RECEIVED
August 26, 1980
COMMENT TO PLANNING BY
September 12, 1980
FOR MEETING OF CASE OF
~l" PU.!,~LIC WATER NO. AVAILABLE TO PETITION AREA
~¢~UIBLIC SEWER~NOT, ,AVAILABLE TO PETITION AREA
REVIEWER'S COMMENTS:
71-014 (Rev. 2/78)
5/£ V£~ CD~,£ST SUB
SUR VE YOR'S CERTIFICATE
PLAT,APPROVAL
'ACCEPT,ANCE OE DEDICA ?"ION
CER T/F/CA TE OF OWNERSHIP and DEDiC,A T/ON
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N£ ~/~ Y AVE.
~,'~ ~;~..
TAX CERTIFICATION
paid.
Date
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