1985-404 BUILDING PERMIT
TOWN OF QUEENSBURY No 85 - 404
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Vernon Burkhart
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OWNER of property located at Seeley Road , Cleverdale Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Sewage Alteration C
at the above location in accordance to application together with plot plans and other information hereto filed and Ij
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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t_ OWNER'SAddressis Cleverdale , No Y .
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2_ CONTRACTOR or BUI LDE R'S Name
Condon Septic and Drain Service
3_ CONTRACTOR or BUILDER 'S Address
17 Grant Ave ,
Glens Falls , No Y . m
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4. ARCHITECT'S Name C
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S. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X) I i
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( ) Wood Frame i ! Masonry I ) Steel
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7. PLANS and Specifications
No. 300 gallon grease trap . 90 LF the field for
grey water only per plot and application submitted . :�
8, Proposed Use
Sewage system for dwelling
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$ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES August 1 19 87 'rD
(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.) rt
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Dated at the Town of Queensbury this I s t day of August 19 85 w
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SIGNED BY / �I ^- .� tG _ for the Town of Queensbury �5
Building and Zoning I nspector '
TOWN OF OUFFNSBURY TOWN 01V Qur=ENSBURY
BUILDING & ZONING DEPARTMENT Fm 0MV F
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S£kTAGF DISPOSAL PERMIT APPLICATION AoG
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1 . CJwn er ' s Name 1116 ►'l/ i 1 1 � - - 91 W I- F�* 9 0 0 a lal o rz
Address "Se LeL- ��_-__ — .+t.,. q` U •• N �`f' �
Telephone No .
2 . Property location
3 _ Name of person or firm responsible for installing system Coll `RAJ
..4- V i Telephone No . I
Address f o k-' A AJ 4e. l�,j:(eJ VS ilk Z �IV� a qLA
4 _ Number of bedrooms ( residential buildings only )
5 . Daily flow gallons/day
6 . Septic tank capaci y 19 O0 ,R ry -F gallons
7 . Topography . flat , ling , steep
% of slopey
so Nature of soil and depth
9 . If ground water , bedrock or impervious material is apparent at what
depth does it begin? -W ., fto
10 . Percolation test : A is required
B 40 _-is not required /// '
C If required what is the rate /"'' g minutes/i.nch
ll . Water supply . municipal , ell , other /�
12 . Type of system proposed : drywe the fi Veld , other R &dS�E '7fk'r,z�f
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
Queens�b7ury X46K2/S/annitary Sewage Ordinance .
Date / s '
slgnat 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
Form 3- 82 P� fF J 3 D a '� � �
TOWN OF +QUEENSBURY
Building pepast men"
i s Data�-
p+ereerii thOw
No. �_ .� W ca..
Remarks
ExcaVetian
FaOtin Farr+a-fi
Footin & piers
Foundation
Cement Coat
Water roofin
Bacxfill
Final Surve
Framin
shea th i.n
Roof Felt
Roofin
siding
Masonr veneer
Rou h Plb -
Relief valves
Wall, Board
Sxt , ,porches
Finished Floor
InterlOr Trim
Stairs & Railin s
Cellar Dr , Tile
Concrete Floors
Pl . Fixtures
Gar . Fire .roof in
VIpor Closers
,Chimne
Water Meter Inst , _
Se tic A roval
Floors
round tiOn
Insulation Walls
Cellin
'G ( ding rnspect0r
8ux
REMARKS
V nJary 3v �t �'i' x-�� R t �7 (, rawf
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