1985-117 BUILDING PERMIT
TOWN OF QUEENSBURY No. 85- 117
• �. � .+ /^y WARREN COUNTY, NEW YORK
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PERMISSION iis hereby granted to Top 01 The World Associates '0
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OWNER of property located at Entrance opse — Lockhart Mt . Street, Road or Ave.
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in the Town of Queensbury, To Construct or place a , Sewacie alteration m
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1 . OWNER'S Address is
RD # 1 Box 1390 �+
Lake George , New York Qn
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2, CONTRACTOR or SUI LDER'S Name pYi
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3- CONTRACTOR or BUILDER'S Address
same
4. ARCHITECT'S Name
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5- ARCHITECT'S Address n
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5. TYPE of Construction — (Please indicate by X) N
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{ ) Wood Frame { ) masonry { I Steel { 1
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7- PLANS and Specifications
200 LF tile field/4 @ 50 ' - 1000 gallon septiC tank
No- per application submitted. . S'l'
B. Proposed Use ;*
Sewage system for dwelling
$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 15 t9 $ 7 �
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
38,
town of Queensbury before the expiration date.) U0
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Dated at the Town of Queensbury this l 5th Day of April 19 85 :1:1
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SIGNED BY for the Town of Queensbury F1
Building and Zoning lnspectoKeov
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TOWN OF OUFFNSBUR'Y' f r €� I
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BUILDING & ZONING DEPARTMENT f '
SFF'AGF DISPOSAL PERMIT APPLICATION 1%5� �, �
A-M6 PAC
1 . Owner ' s Name i o``fa 6 ZG� t S-5'�a f' r.x?T S 9 1 11) � 12 U1415316
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Addres s� ' �c�lr1 // /-r. C� " c r�,�.
Telephone
2 . Property location
3 . Name of person or firm responsible for installing system c7 / 71,5-
���/y. Telephone No . 4 '`w J " 1 5�
Address
4 . Number of bedrooms ( resident±//al buildings only )
5 . Daily flow /z50 / ,I � gallons/day
6 . Septic tank capacity gallons
7 . Topography : flat , rolling , steep
% of slope
8 . Nature of soil and depth x.-C 0 01�
J . if ground water , bedrock or impervious material is apparent at what
depth does it begin? ft .
lU . Percolation test : A is required
B is not required
C if required what is the rate minutes/inch
11 . Water supply . municipal , well , other
12 . Type of system proposed ; drywell , tile field , other `75 X' V1,f
Any contractor , corporation , individual, eats . engaged In ==thhee construction
of a sanitary sewage disposal system who covers the same before inspection ,
does not have an approved permit , or varies from the approved application
will be subject to a penalty of $ 250 as provided for in Se 6 . 010 of the
Queensbury Sanitary Sewage Ordinance .
Date ''
r%lofgnature of &ppllcant
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions , including distance from any structure , distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself .
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Form 3 - 82 /