1985-546 BUILDING PERMIT
TOWN OF +Q'UEENSBURY No. F1 c; _ 5A6
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Mar Bode wel sec (Allpenhaus Motel )
OWNER of property located at 24 Lake G eor a Road � Stre-et. Road or Ave.
in the Town of Queensbury, To Construct or place a Sewacre Alteration c�u
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_
t . OWNERS, Address is 24 Lake George Road
Glens Falls , New 'York. �
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2, CONTRACTOR or BUILDER'S Name �
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Sanitary Sewer Service
3. CONTRACTOR or BUILDERS Address (D
P . D . Box 224 t::$
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Glens Falls , New York
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4. ARCHITECT'S Name 3
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S. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by XI 0
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( ) Vyood Frame I 1 Masonry { 1 Steel f I
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7. PLANS and Specifications
lost . box ( 2 ) - ? " x8 " drywalls with 241' # 3 stone QQ
No. per plot and application submitted . (D
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S. Proposed Use 0)
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Sewage system for motel
$ 10 . ) 0 PERMIT FEE PAID — THIS PERMIT EXPIRES Sept ' 24 79 87 (D
(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.)
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Dated at the Town of Queensbury this 2 4 th Day of S ePt . fg $ 5
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SIGNED BY for the Town of Queensbury
Building and zoning I nspector
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TOWN OF QUFFNSBURY
BUILDING & ZONING DEPARTMENT TOWN OF QUEEN'SguR`f
T SEWAGF DISPOSAL PERMIT APPLICATION E C rF= I Fm
1 . Owner T s Name ,/r � � Il �
AaW c 7 $
Address 9 1 2� gi4�S �G
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Telephone No . _ � ! �
2 . Property location
3 . Name of person or firm responsible for installing system
�A I _1 e<c " V k' tJ rt AL Telephone No ,
Address_
� _ Number of bedrooms ( residential buildings only)
5 . Daily flow ,/ C� kf or<c C UA) .T-.0 Iy
6 . Septic tank capacity a 4 z5zo2oe gallons
7 . Topography : flat , ) rolling , steep
8 of slope
8 . Nature of soil and depth_ 1� S
90 if ground water , bedrock or impervious material i,s apparent at what
depth does it begin? ft .
10 . Percolation test : A is required
B jx '~is not required
C If required what is the rate minutes/inch
11 . Water supply : municipal well , other
12 . Type of system proposed : drywell the field , ether
Any contractor ,. corporation , individual , etc . engaged in the coixstri.ict±on
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 ti f c7 ignature cYt a 11cant
On separate sheet of paper submit a diaramn of the proposed septic system
with all dimensions , including distan; a from any structure , distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself .
Form 3-82
TCa►Wt4 OF QUEE14SBURY
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