1985-283 BUILDING PERMIT
TOWN OF QUEENSBURY No_ 85- 283
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Josephine M . Kane
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OWNER of property located at r 67 "4=,S Aviation Road Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Sewage 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_ C-I
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1, OWNEFI'S Address is 193 Aviation Road ui
Glens Falls , New York (D
2. CONTRACTOR or BUILDER '.^s Name m�
Sanitary Sewer Service
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3. CONTRACTOR or BUILDERS Address tj
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P . 0 . Box 224
Glens Falls , New York
4. ARCHITECT'S Name
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5. ARCHITECT'S Address w
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S. TYPE of construction — (Please indicate by X) rt
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( 1 Wood Frame ( ) Masonry ( I Steel I l t:3
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7- PLANS and Specifications 0
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No. 1 - 7 tx8 r d.rywell and 24 " # 3 stone per plot and
application submitted ,
a. Proposed Use
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Sewage system for dwelling
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$ 10 _ 00 PERMIT FEE PAID -- THIS PERMIT EXPIRES June 12 1g 87
(If a longer
g period is required an application for an extension must be made to the Building and Zoning inspector of the N
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 12 th Day of Jun a 19 85 p
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector _
TOWN OF OUFFNSBURY
! BUILDING & ZONING DEPARTMENT TOWN OF QUEENSBU"Y
! r SEWAGE �DISPOSAL PERMIT APPLICATI � � � �! V
Owner ' s Name �� 1 \ Id 1 U 'v1 1985 v
f O � P.
Address c r t/� 14.M: 11213141516
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Telephone No .
2 . Property location
3 . NanvQof person or firm responsible for installing system
IfJ l `f ✓' G Telephone No
Address r a FIII PqP
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4 . Number of bedrooms ( residential buildings only ) -
5 . Daily flow , D gallons/day
6 . Septic tank capacity gallons
7 . Topography : 1116at rolling , steep
o slope
8 . Nature of soil and depth ( "O
9 . If ground water , bedrock or impervious materi is apparent at what
depth does it begin? ft .
10 . Percolation test ; A ✓pis required
B is not required
if required what is the rate }minutes/ inch
11 . Water supply : unicipal 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 p a e or in Sectio 6 . 010 of the
QueensburyS nary Sewage Ordinance .
Date (,.,
ag LP131i t
On separate sheet of paper submit a diagra 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 .
Form 3 - 82 ' 2
TOWN OF QUEENSSURy
Buildiae- Departanent
P
weather
Remy rlcs
ExcaQa ti on
Foati Forms
Pootinq & Piers
Foundation
Cement Coat
A►ater roafin
BacJicfill
Final curve
Examing
Shea thi
Roof Pelt
Roofin
Siding
Masonr veneer
Rou h PI
Relief valves
Wall Board
ext . Porches
Finished Floor
Interior Trim
Stairs & Railin s
Cellar Dr . Tile
Concrete Floors
PI Fixtures
Gax . Fire roofin
Door Closers
Chimne
Water Meter Inst .
se tic A royal '
Floors
Xnsulation Poundation --
Ceili
Building _.-n�gsaatar
REMARKS
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SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N . Y. 12801
TELEPHONE 792-7257
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