1985-544 BUILDING PERMIT
TOWN OF QUEENIISBURY No. 85- 544
WARREN COUNTYt NEW YORK (D
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PERMISSION is hereby granted to Beatrice Mandl o 0
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OWNER of property located at Luzerne Road Street. Road or Ave. 0
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Sewage. Alteration 0i
in the Town of Queensbury. To Construct or place a
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.
1 _ OWNER'S Address is RD #: 4 Luzerne Road
Glens Falls , N . Y .
2. CONTRACTOR or BUILDER'S Name
Reliable Sewer Service
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3. CONTRACTOR or BUILDER 'S Address (D
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Luzerne Road. �
Glens Falls , New York CD
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4_ ARCHITECT'S Name W+
S. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X)
1 ) Wood Frame ( ) Masonry ( I steel ( )
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CIS
7. PLANS and Specifications :'
1000 gallon tank , disc . box and V xS ` drywell per �
No. plot and application subrnitted. . (D
8_ Proposed Use
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Sewage systeln for mobile home dwelling
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES
September 23 19 87 ti
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Qusensbury before the expiration date.)
Dated at the Town of Queensbury�tthis 23rd Day of September 1985
SIGNED BY _ /I ` UL tit J �. ��- vs� L* nl for the Town of Queensbury
Ouildirig and Zonirig I nspe
TOWN OF QUFFNSBURY
BUILDING & ZONING DEPARTMENT TOWN OF QUEENSSURY
SFV%7AGF DISPOSAL PERMIT APPLICATION 1E
0 En IV F
�rrt 7'Yi c <' M el n d" 9
1 . Owner ' s Name tL 4i ICIQ9
Address
Telephone No
2 . Property location
3 . Name of person or firm responsible for installing stem
Telephone No . % 7 z / S
Address f ]/
4 _ Number of bedrooms ( residential buildings only )
5 . Daily flow ' s t7 gallons/day
6 . Septic tank capacity ci C. gallons
7 . Topography : flat , rolling , steep
$ of slope
8 . Nature of soil and depth
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9 . if ground water , bedrock or impervious material is apparent at what
depth does it begin? ft .
10 . Percolation test : A is required
is not required
C 3f required what is the rate minutes/inch
11 . Water supply : municipal , well , other
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
Queensbur/y,+ Sanitary sewage Ordinance .
Date / i J ' - L
(1 signa` ure app scant _
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 , etco include all dimensions of
the system itself .
Form 3 - 82
TOWN OF QUEENSBURY
Busldiu r- Department
1� Coate
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Name es>
Pssmit Piz
Call
Excalyat on
Footin Forms
Footin & Piers
Foundation
Cement Coat
Water roofi.n Wawa
Backfil3
Final Surve
F,tamin
SheatJillhin
liiiiiiiiiiiiiiiiiiiiillillill
,Roof Felt
Roof
Sidin
Masonry veneer
Rou h Pilll
Relief Valves
Wall Board
Ext . Porches
F.intshed Floor
Interior Trim
Stairs & Railin s
Cellar pr . T-I
Concrete Floors
plkg , Fixtures
Gar . Fire roofin
,Dc wor Cl users
Chimney_
Water Meter Inst .
Se tic A roval
Foundation
Insulation Walls
Ce-!I
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Building Inspector
REMARKS
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