1985-106 BUILDING PERMIT �
TOWN OF QUEENSBURY No. 85- 106
WARREN COUNTYO NEW YORK
PERMISSION is hereby granted to Dr • John Canavan
OWNER of property located at
21 Pinewood Avenue Street. Road or Ave.
in the Town of Queensbury, To Construct or place a Sewage Alteration r
at the above location in accordance to application together with plot plans and other information hereto filed and
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approved and in compliance with the Town of Queensbury 'Building and Zoning Ordinance. �
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7 . OWNER'S Address is 21 Pinewood Avenue C
Glens Falls , New York
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2. CONTRACTOR or BUI LDE WS Name
Sanitary Sewer Service
3. CONTRACTOR or SUI LDE R'S Address
53 Fourth St . r.s
Glens Falls , New York
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by XI
f ) Wood Frame f ? Masonry { 1 Steel ( )
7. PLANS and Specifications
2 - 71x8 ' drywells with 24 " # 3 stone
No. 1 - dist . box
per plot plan and a-pplication submitted .
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S. Proposed Use fD
Sewage system for dwelling
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 11 19 87
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the O
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this
-y,11th Day of Afar 11 19 85
SIGNED BY ` ` for the Town of Queensbury
or
Building and Zoning lnspert
TOWN OF QUFFNSBURY TOWN l,B�cY S NJIngY'
BUILDING & ZONING DEPARTMENT � ib i{t l`l
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SEF?AGF DISPOSAL PERMIT APPLICATION i� ��+ uw , r y .�
1 . Owner ` s Name ,F1k' Ft � f� {. �
Q A.M.
Address l E N� _c�u�� �1 ► +"' rz� 171g )91i! � 111,2) 11213) 41516
Telephone No .
2 . ' Property location
3 . Naof person or firm esponsib a for installing system
e, e.. a e1 Telephone No .
Address
4 . Number of bedrooms ( residential buildings only )
S . Daily flow gallons/day
6 . Septic tank capacity 0o 0 gallons
7 . Topography : flat , rolling , steep
of slope
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$ . Nature of soil and depth At LA
9 . If ground water , bedrock or impervious mate ial is apparent at what
depth does it begin? f ft .
10 . Percolation test : A is required
B is not required
C If required what is the rate 0 '%Y�minutes/inch
11 . water supply : municipa] well , other
12 . 'Type of system proposed : rywell the field , other
Any contractor , corporation , individual , etc . engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection ,
does not have an approved permit , or yzs . ies m the approved application
will be subject to a penalty of $ 25Q �as provid d for Lion 6 . 010 of the
Queensbury Sanitary +Sewage Ordiinan e .
Date
ry -7 s gnature of 1 can
On separate sheet of paper submit a diag am 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 - $ 2 RoA
ToWK of: QUEEN58URY
Building Department
b"Vec t°rs Reps Date
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116,111111111111 1111PP 11W Bather
Fermat No.
Remarks
11
Excavation
Footin Forms
root-in
Piers
Foundation
Cement Coat
Water roofin
Backfill
- Final Survey
Frarrtin
- Sheathin
Roof Felt
Roofin
- Siding
Masonr Veneer
ROucfh PIb
Relief Valves
Wall Board
Ext , Porches
Finished Floar
Interior Trim
stairs & Railin s
cellar Dr . Tile
concrete Floors
PI jr , Fixtures
Gar . Fire roofin
Dour Closers
Chimnezl
Water Meter xnst .
Se tic A royal
Fza�°-ram
Foundatian --------
Insulation yv*alls
Cell in
Building
Inspector
REMA1 K5
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SANITARY SEWER SERVICE
Division of G. P. DrellosI Inc.
53 FOURTH STREET GLENS FALLS, N . Y. 12.801
TE LEP N E 792-7257
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