1985-418 BUILDING PERMIT
TOWN OF QUEENSBURY
No. $ 5-4 IS
] tt� r WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Erskine Fowler
OWNER of property located at rib Bay and Haviland Roads Street, Road or Ave. ill
7s'
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 (D
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is RD # 1
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Fart Edward , New York 12828 Is
2. CONTRACTOR or BUILDER'S Name
Glen ,zones
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3. CONTRACTOR or BUILDER'S Address Ii
Argyle , New 'York p,
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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
I ) Wood Frame ( # Masonry { I 'Steel i #
7. PLANS and Specifications
No 1000 gallon tank , disc . box and 2 6 ' x8 ' d.rywells
per plot and application submitted . r„
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S. Proposed Use P)
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Sewage system for dwelling
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S 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES August 6 19 87 F1
{If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration data-) p
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Dated at the Town of Queensbury this
6th Day of August yg 85
SIGNED BY / t7 4- for the Town of Queensbury
Building and Zoning Inspect
TOWN OF OUEE.NSBUR'Y TOWN 4F" QUEENSBURY
BUILDING & ZONING DEPARTMENT E0 V E
• SEP?AGF DISPOSAL PERMIT APPLICATION
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1 . Owner ' s Name H.M. fU°-' �` �i4 � Ca P.M.
Address -
Telephone No . -- - y z- (�� .i ;`
2 . Property location C c c a_
3 . Name of person or firm responsi le for installing system
Telephone No .
Address
4 . Number of bedrooms ( residential buildings only ) r
5 . Daily flow 3 C7C7 gallons/day
6 . Septic tank capacity gallons
7 . 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 required
B ,>< is not required
CIt requi.Fed what is the rate - minutes/inch
11 . Water supply : municipal , well , other UJ s,-LL..
12 . Type of system proposed : drywell , 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 for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance .
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Date _. •• _ • ..•• r
signature cff 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 .
Form 3 - 82
wrOWN OF CUEENS$URY
g,uq]dis„ p�,Pa,rtment
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