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ALASKA NATIVE TRIBAL HEALTH CONSORTIUM Div is i on of Env ir o nm e nt a l He a lt h E ng i n eer i ng 45 0 0 D ip l om ac y Dr i v e. O. Box O Juneau Alaska 99811-1800 DOMESTIC WASTEWATER SYSTEM OWNER S STATEMENT This information is required by 18 AAC 15. PLEASE KEEP THIS PAGE FOR YOUR RECORD AND REFERENCE http //anthc.org/wp-content/uploads/2016/01/May-2016-ANTHC-SS-Individual-Sanitation-Facilities-Application.pdf Date Stamp of Received Application Applicant s Name Spouse s Name A....
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