applications _-__a. ..._'
OFFICE USE ONLY . _______________
l� L�
TAX MAP NO. PERMIT NO. �e 22�-• ` ;
FEES. PERMIT •C(Qb J N � r
` RECREATION, ENG EERING ,
- - 3 1"IN OF I 'S;3LiRY�,
PRINCIPAL STRUCTURE: APPLICATION F C®l'o1vIlRU Y DEQ✓EtOPMENT
PERMIT ZONING APPROVAL & B
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: -4-,OWNER:
ADDRESS: ADDRESS:
PHONE NOS. q 3 '��7 J PHONE NOS.
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: �C
PHONE:_ ale i .Z$�t,�,
LOCATION OF PROPERTY: ``zij y k 7
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVAL? ES ❑ NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z � x d w
PROJECT O ¢ O O d LU w
o w � U- i; U- W Q a = =
z ¢ Q � cn N � F- 1.- o ~ ° w �
�- LL a = 06
SINGLE FAMILY
c 9-o 1`
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS_}
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED /
GARAGE() X L `t
OTHER L 1+0
���/// t�G
Town of Queensbury Community Development Office 742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: !N
ESTIMATED CONSTRUCTION COST: k-n oc^c FUEL TYPE:
HEAT TYPE: *HOW MANY FIREPLACE(S):-_(Z AND/OR WOODSTOVES(S):-
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE?
IS THIS A HISTORIC SITE?
PROPOSED USE OF BUILDING OR ADDITION: �j. ICAL 'i—Ca -
�-, 1`C -� cit. L r
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?
ARE THERE EASEMENTS ON PROPERTY? ,
*Please complete a separate Application for"Fuel Burning A;N,;�:: ;tiir, j;`available ir,our office
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning re ns. I acknowledge that prior to occupying the
facilities proposed, I or my a s will oda:n a certificate of occupancy. I also understand
that I/we are required to vide an as-tui urvey by a licensed land surveyor of all newly
constructed facilities 'or to issuance CpaMi to of Occupancy.
I have read and gree to
Signed
Dire to 7ofBuildinq & Codes: 761-8256 (for questions regarding Building Permits, construction codes
or tic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
Town of Queensbury Revised 4/14/2010
Highway
Michael F. Travis
Department
Highway Superintendent
742 Bay Road, Queensbury, NY 128( V Home (518) 798-0413
41
Office Phone: (518) 761-8211 TOWN OF Q E ENSE-1 U RY Thomas R. Vanness
Fax: (518) 745-4466 1 COMMUNITY DEVELOPMEtJ Deputy Superintendent
Home (518) 745-0929
DRIVEWAY PERMIT www. Queensbuty.net
Date: 95
Applicant Name:
—C
Address to be inspected: r7 C
Return Address:
Applicant must show exact location and width of driveway(s) to be connected to the highway by placing
stakes at the specified location.
The Superintendent of Highways of the Town of Queensbury has reviewed this application. The following
action has been taken:
Step 1: Preliminary Approval
Need: Slight swale
Deep swale
Level with the road
Level with the top of the paved wing
Size culvert pipe to be used (if necessary)
( ) 12" ( )15" ( ) 18" ( )24" )36"
Preliminary inspections completed by: Date:
Approved by Higway Supt: Deputy Supt.:
Upon completion, please resubmit this approved permit for a final approval.
Step 2: Final Approval
Rejected
Date:
Michael F. Travis, Highway Superintendent
Thomas R. Van Ness, Deputy Highway Superintendent
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
OFFICE USE ONLY
Revised 4/14/2010
TAX MAP NO. PERMIT NO. PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT.
OWNER:,
INSTALLER:
ADDRESS: ADDRESS: e
PHONE NOS.
PHONE N05._ ? ��i 7C� _' j -�7 7
LOCATION OF INSTALLATION: 1 25, ( Lt
YEAR BUILT NO.OF X COMPUT TION RESIDENCE INFORMATION:
BEDROOMS Gallons per bedroom - ( TOTAL DAILY FLOW
1980 or olderX 150 = GARBAGE GRIN
INSTALLED?
1981 -1991 X 130
SPA OR HOT TU
1992-present X 110 = G INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?��
DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[ p7 m i
(Test to be completed by a licensed professional engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer
or architect(unless installed in a Planning Board approved subdivision). - y/
TANK SIZE: ' GALLON(MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size f ke septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE:
- B ORPTION FIELD(WITH NO.2 STONE) Total length 72C� ft. Each trench 2 X 5 io
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
Q HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval
granted which is based upon ' gra l , din reliant pon any material misrepresentation or failure to make a material fact or
circumstance known by n behalf of/an applic s all be void.
I have read the re ations with resp 0 ' application and agree ���� --`
to abide by the and a eq f e T 'n of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sew a Di s rdi / � c seen;bury.nat \
7 VISIT OUR WEBSITE FOR MORE INFORMATION
Sig erso esponsible Date �� v., aueensburtr,net
Town of Queensbury* Community Development Office *742 Bay Road, Queensbury NY 12804