1985-292 BUILDING PERMIT
TOWN OF QUEENSBURY No. 85_ 292
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to. An +- YonNz Pol i a0yz -----
OWNER of property located at 4 Ames Place Street, Road or Ave. 'C
ro
in the Town of Queensbury, To Construct or place a Sewag e Altercation O
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. 0
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1 . OWNER'S Address is 4 Ames Place
Glens Falls , New York
2. CONTRACTOR or BUILDERS Name
Small Tyme Excavating Q
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3. CONTRACTOR or BUILDEH S Address W
3 Palmer Ave, Vd
Corinth, New York P1 w
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4. ARCHITECT'S Name
S. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
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{ I Wood Frame { I Masonry { ) Steel
7. PLANS and Specifications
new dist. box , 5 ' x8 ' drywell and # 2 stone per plat and
No• application submitted .
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8. Proposed Use
Sewage .Alteration for dwelling
$ 10 . Ua PERMIT FEE PAIL! — THIS PERMIT EXPIRES June 21 19 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 date-)
Dated at the Town of Queensbury this 21_St/}� Day of June 19 85
SIGNED BY _ C +r" �� • for the Town of Queensbury
8uitdIng and Zoning I nspector
TOWN OF QUFFNSBURY TOWN OF QUEENSBUR`t
BUILDING & ZONING DEPARTMENT E SFF'AGF DISPOSAL PERMIT APPLICATION IR 0
1 . Owner ' s Namei
an
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Address JdF
Telephone Noe P • °
2 . Property location
3 . Name of person or firm responsible for installing system
► rI- �r Vic . . zr; Telephone No .
Address
4 . Number of bedrooms ( residential buildings only ) .
5 . Daily flow gallons/day
6 . Septic tank capacity .if.,/ ? gallons
7e Topography : &flat�` 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 reauired
B is not required
C If required what is the rate minutes/inch
Ile Water supply : municipal , well. , other
12 . Type of system proposed : drywell , -tile 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 for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance .
Date A-
signature of applicant
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 .
No to S 7
Form 3 - 82
TC3'V11'N OF QUEENSBURY
Building Department /
Parmit No. wcathcr
Rema.rxs
_ ExcatSation
_ Footing Forms -
Footing & Piers
Foundation
Cement Coat
Water rooFln
Ba clkfi 12 --
Final survey
Framing
Sheathing -
Roof Felt
Roofing -
siding
masonry Veneer
RoucTh P1 bgRelief Valves
WaII Board -
Nxt . Porches -
Finished Floor
Interior Trim
stairs cmRailings
Cellar Dr . Tile
Concrete Flours
plbq..Fixtures
Gar . Fire roofin .r
Door Closers
Chimney
Water Meter rnst .
S+e tic A .royal
Floors
Poundation
Insulation Walls
Ceilin _......._.__
Building Xns crOr
REMARKS
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