1985-169 BUILDING PERMIT
TOWN OF QUEENSBURY No. 85- 169
WARREN COUNTY. NEW YORK
PERMISSION is hereby granted to James and Kar line Roberts C-4
OWNER of property located at 1_5 ,$�►l v n Afrer+LC Street, Road or Ave. (D
zn
p)
in the Town of Queensbury, To Construct or place a Sewacre Alteration �
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-
1- OWNER'S Address is
15 Sylvan Ave _
Glens Falls , New York fD
D
Cr
2- CONTRACTOR or BUI LDER'S Name Ip
fi
Bill Threw Excavating rt
rn
3. CONTRACTOR or BUILDER'S Address
RD # 3
Glens Falls , New York
cn
4. ARCHITECT'S Name
f1]
'C
l�
C
S. ARCHITECT'S Address
C
(D
6. TYPE of Construction — (Please indicate by X)
{ ) Wood Frame { ) Masonry f ? Steel f }
7- PLANS and Specifications
repair to existing system - 2 drywells 6 ' xS ' M
No- with # 3 stone and new d i st . boxic
Cu
(ID
B- Proposed Use
Sewage system for dwelling a"
,-f
rn
*f
w
1U . 0U May 7 is 87 N.
$ PERMIT FEE PAID — THIS PERMIT EXPIRES f]
l I f 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 date.)
Dated at the Town of Queensbury this 7 t h n Day of
May 19
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector ''
TOWN OF OUEENSBURY
BUILDING & ZONING DEPARTMENT
SEWAGE DISPOSAL PERMIT APPLICATION
_ _TO'J'VEV OF 4UIEENS9LIRY
1 . Owner ' s Name
Address f �~ L t/ dJJ A v
r L9�0 1 Telephone Vd& ~ -S /
213141516
2 . Property location
3 . Name of person or firm responsible for installing system
Telephone No . �7072ak '7& /
Address cic�r's✓, _ ��+
4 . Number of bedrooms ( residential buildings only )
5 . Daily flow 0 gallons/day
6 . Septic tank capacity C7CJ gallons
7 . Topography : fla 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? f t .
10 . Percolation test : A is required
B is not required
1 required what is the rate minutes/ inch
11 . Water supply : well,, other
12 . Type of system proposed. : drywel 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 varies from the approved application
will be subject to a penalty of $ 250 as provided fo Lion. 6 , 010 of the
Queensbury Sanitary Sewage ordinance _
Date - J ~
signature o applicant
On separate sheet of paper submi a d ' agram of the proposed septic system
with all dimensions , including di ce from any structure , distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself .
Form 3 - 82 s' .• �
TOWN OF QUEENSBURY
aulaJI&S: pev rtmeut
Dates
;:
L s tY
ocadon Weather
Remarks
gXcat7a t ion
Footin Forms
6 ,Piers
FoOtin
Foundation
cement coat
Water roofin
Backfi2l
Final Surve
Framin
Shea thin
Roof Fe2 t
Roofin
Siding
Masonru 'Veneer
Rou h Pj b
Relief Valves
Wall Board!
Sxt . Porches
Finished Floor
Interior Trim
Stairs & 'Raiile
in Is
cellar graTile
Concrete Floors
pl Fixtures
car . Fire roofin
Door C20sers
chimne
Water Meter Inst ,
Se tic A raval
Floors
1°�dr2n�.f DYl ..�---"—
Insulati.on Walls
Cei2i
Bui2c3ing Inspector
,�} REMARKS - y
,
,
" 1
_
r.,
Am
-
t ! -- - - -
1
u ,
S 2�
ILL
LILL-
r p1
- C _
_ b _
i w