1985-532 BUILDING PERMIT
TOWN OF QUEENSBURY No_ 85- 532
WARREN COUNTY, NEW YOiRK �
PERMISSION is hereby granted to William .T . Levandowski
OWNER of property located at 10 Haven Lane Street, Road or Ave. Ca
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.
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1 . OWNER'S Addnsss is o
10 Haven Lane
Glens Falls , New York
2. CONTRACTOR or BUi LDER'S Name Sanitary Sewer Service
3. CONTRACTOR or BUILOEFVS Address
F^'
p . 0 . Box 224
Glens Falls , New York
4. ARCHITECT05 Name C
CD
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5_ ARCHITECT'S Address (U
6. TYPE of Construction — (Please indicate by X)
I 1 Wood Frame ( I Masonry ( ) steel ( �
7. PLANS and Specifications
replacing system for washing and kitchen waste only
No. will add 1000 gallon septic tank , 1 71x8r drywell
with 24 " 02 or # 3 stone per plot and application . Q
S. Proposed Use
W
Sewage syketn for dwelling
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Sept. . 20 19 87 0
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Ckwensbury before the expiration data.)
Dated at the Town of Queensbury this 2 0 t h Day of /� �Sept . 19 85
SIGNED BY / / / OAJLf . for the Town of Queensbury
Building and 2onirp Irtsgector QfW
TOWN OF QUEENSBURY
�x s, BUILDING & ZONING DEPARTMENT
SEWAGE DISPOSAL PERMIT APPLICATION tawf4 `4� 0-ViC&T48s1r rtv
] . Owner ' s Name 1% a E V cr• �`
Address ( C3 F t + is � A N � � r; r 1 t3 !',�5
Telephone No .
2 . Property location.
3 . Name ofperson or firm responsible for installing system
C, iU l c.� Sf w �✓ R a Telephone No . `7 q 1 - r ?
Address s Bns, i2 `i
4 . Dumber of bedrooms ( residential buildings only) .AL/A _
5 . Daily flow. C�C> gallons/day
6 . Septic tank capacity /� C) t7c�+ gallons
7 . Topography : flat , rc) lling , steep
of slope f �L �
8 . Nature of soil and depth ufr*0 I
9 . If ground outer , bedrock or impervious material is apparent at what
depth does it begitx? f t 0
10 . Percolation test : A is required
By is not required
C I required what is the rate minutes/inch
ll . Water supply : municipal , well , other ZdA:/ �f d r '9 � -
12 . Type Of system prapOsed. : drywell , the field , othery� /fd�-� C -
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
Queensbu.ry Sanitary Sewage Ordinance .
Date t1z h gnat�t a of a Li cant
On separate sheet of paper submit a diagram'
iia raamm of the proposed septic system
with ail 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 W( LC A 10C)0 + rr G- SG 27`1 T Axfe
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TOWN OF QUEENSBURY
Building Department
Name—
FE
Remarks
Sxca t can
Footing Forms
Footing 6 PI ers
Foundation
Cement Coat
waterproofing.
Saokflll
Final Surve
Framf n
Sheathing
Roof Felt
Roofing
Sldin
Masonry Veneer
Rough PZ
Rellef Valves
Wall Board
sxt . Porches
Finished Floor
Interior Trim
Sta3ra & Railings
Cellar Dr . The
Concrete Floors
PI . Fixtures
Gar. Fire roofln
Door Closers
ChdanqhL
Aster Meter Inst .
Se tic Approval Loof
,
Floors
XnsulatIon Foundation
Ara l l s
Du.t diary Inspector
REMARKS
y SANITARY SEINER SERVICE
LUZERNE RD. GLENS FALL'S N.Y. PHONE 792 - 7257
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