1985-053 BUILDING PERMIT
TOWN OF QUEENSBURY
NO. 85 - 53
WARREN COUNTY, NEW YORK.
PERMISSION is herebyWayne R , p�
granted to y Holcomb
OWNER of property located at O'awt'1 Road m
Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and 0
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. ~
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f. OWNER'S Address is RE) # 3 Dawn Road
Cs'
Glens Falls , New York
2. CONTRACTOR or BUI LDEWS Name
Frank Shaw
a
3. CONTRACTOR or BUILDEWS Address `WW'
Kobor Road
Gansevoort , New York
a
A. ARCHITECT'S Name
a
S. ARCHITECT'S Address
B_ TYPE of Construction — (Please indicate by X) rn
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6 } Wood Frame l } Masonry l ) Steel ( ) W
7. PLANS and Specifications
fD
Na. 1200 gallon septic tank , dist . box and 187 LF the r~i
field per plot and application submitted ,
8_ Proposed Use
r O
t.
Sewage system for dwelling �j
$100 00 PERMIT FEE PAIL? — THIS PERMIT EXPIRES March 26 87
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration data.) -
Dated at the Town of Queensbury this 2 6th Day of March tg 85
SIGNED BY a - for the Town of Queensbury
Building and Zoning Inspector
M
TOWN OF QU' EENSBURY
BUILDING i 'ZONING DEPARTMENT ;tr
SE%7AGF DISPOSAL PERMIT APPLICATION TOWN Cl Q
1 . owner s Name MAR 5 ,
Address R
Telephone NO �'` Ion
i
2o property location
3 . Name of person or firm responsible for installing system
Vt Telephone No . l q
Address C
4 . Number of bedrooms ( residential buildings on� y)
gallons/day
5 . Daily flow
gallons
6 . Septic tank capacity
7 . Topography : 'fiat rolling , steep
% of slope
8 . Nature of soil and depth ''
9 . If ground water , bedrock or impervious material is apparent at what
depth does it begin?
ft .
l0 . PercolationA is required
testa B is not required
C If requsred what is the rate minutes/inch
110 water supply : municipal , well , other
12 . 'type Of system proposedn drywell , the field , other
A contractor , corporation , individual , etc . engaged in the construction
of a sanitary sewage disposal
tem who or variesvers fromtthesapprovedame rapplicationn ,
does not have an approved p in Section 6 . 010 of the
will be subject to a penalty of $ 250 as Provided for
Queensbury Sanitary Sewage Ordinance .
Date 2 " # "' g1. a ure o app scant
Septic
stem
on separate sheet of paper submit a dig r of the puctureC, distance from
with all dimensions , including distance f tc .rom aninclude all dimensions of
property line and domestic water supply .
the system itself .
1Eon
Farm 3 - 8 2
TOWN OF CUEEt'S"U"
Buildin= Departmelkt
'�psGpoes Repewt Date
Name
L�ocatiaia W cathee
Pownsit No.
.. �i Remarks
g�rcarJa Lion
Footin Forms
Footin & Piers
Foundation
cement Coat
Water roofin
Backfill
Final Surve
Framin
S heathin
Roof Felt
g,�ofin
Mil Veneer
Rou h P,
Relief Valves
Wal.], Board
Bxt . Porches
Finished Floor
_
Interior
stairs & Railin s
kk Cellar Dr . Tile
concrete Floors
Pl Fixtures --
Gar . Fire roofin
gyp,= closers ----�-�'
Chi rtrne Inat .
Water Meter
Be tic A rova3
Floors
poun�n
Insulation
Walls
Ceil.in
B.11diny in ctor
REMARKS
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