1986-838 ro
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Apri 1 3 1990
(AC\This is to certify that work requested to be done as shown by Permit No. 8 5_838
has been completed.
This structure may be occupied as a an alteration to dwel l inn
inration(�l1 Mannis Road - Glen Lake
Owner Paul Macri , Sr.
By Order Town Board
TOWN OF QUEENSBURY
9/..-7,074,1/41/
A Director of Bldg. & Code Enforcement
{ M; BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-838
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Paul Macri, Sr.
OWNER of property located at Mannis Road, Glen Lake Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Alterations to dwelling Fd
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 Mannis Road
Queensbury, New York 12801
to
•
2. CONTRACTOR or BUILDER'S Name
Glen Powell
3. CONTRACTOR or BUILDER'S Address
RR #1 Bay Road
Lake george, New York
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co4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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° 6. TYPE of Construction—(Please indicate by X) 0
( I Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
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No.
new foundation, renovations and enclosing existing carport 1-1
per specifications and application submitted. 1-4
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8. Proposed Use
One—Family Dwelling (alterations)
a.
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$ 28.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 1 1987
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(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.)
Dated at the Town of Queensbury this 15th Day of December 1986
SIGNED BY //[ l [ /V Q. . u for the Town of Queensbury
Building and Zoning Inspector')
&� 2� Aa ® TO BE .COMPLETED BY BLDG. DEPT.
// Application No. 1
JOWn O Queen3bur y Permit Issued 19 P"�`:'`' f+-,'s D.` `,- '--;
BUILDING and ZONING DEPARTMENT ?' I( I`" !
Permit Expires 19 ;=¢ji,
Bay and'Haviland Road, R.D. 1 Box 98 Zoning Designation i ';{,, r-,, '=" ' ,, j j
Queensbury, New York 12801 Variance No I,ii`.,- ',it-) • Ffi,) 4,cpc
Site Plan eview No , „n. .66
Approv 7 i. �• ,. ' is fezo:) fr:Eic
i ll, j up�`C dk A'yP6`5 � GTTC t
APPLICATION FOR /�/`r.d--- YS
i
BUILDING AND ZONING PERMIT ,__... .-__.._.
* * * * * * * * * * * * * * * * * * * * * * * * * * * *• * * * * * * * # # # #
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description, plans and specifications submitted, and such
special conditions as may be indicated on the Permit. •
The owner of this property is: P4U i AaptCft:t ,E r\
P.O. Address IMtf1Vi5 RdPrD Tel. 793 SSY
Property Location: C b(-R. i'( )-,n jC,_e - Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable)
THE RSON RE NSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
0.644
ea i te0-44, P.9ra cif Z;4 Geer V
ame P.O. dcress Tel. No.
Name of builder Address Tel.
Name of plumber Address Tel.
Name of mason G -e N. Po ca. l( Address gay Rp(4-"lD Tel. "J 9 3 5-41>,tom
10) PAL) Ga)-- FtarD )0-9Cu oR . '?Gf- 3/73
• NATURE OF PROPOSED NORK: * ZONING INP FORMATION:
_Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Addition to a building * drawn reasonably to scale and attached hereto,
'Alteration to a building * showing clearly and distinctly all buildings,
(no change to exterior dimensions) * whether existing or proposed and indicate all
Other work (describe) J=j j j /31syM,,N.j-set-back dimensions from property lines. Give
* street and number or lot number and indicate
\— OR * whether interior or corner lot. Show location
- E ZE
N RUC S T * of water supply and location and configuration
* of septic disposal area.
/4J c t_ bwo g cS j/Uc, * COMPLETE INFORMATION REQUIRED BELOW.
•
(.J crS-L * Size of property ft X ft.
* Existing building(s) Size ft X ft.
*
PROPOSED BUILDING AND USE: `
* Existing building(s) Use
Size of new structure ft X ft *
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
(circle one) * •
No. of stories (habitable space) * Front yard " ft Rear yard ft
Height (grade to ridge) ft. * Side yards ft and ft
If residential, no. of families • * If on corner, .setback from side street ft
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
No. of bedrooms *
* PRIMARY BUILDING -
No. of bathrooms
Primary heating system • x One family dwell •
ing
Type of fuel * Two family dwelling •
No. of fireplaces to be installed * Multiple dwelling / Number of units
Will a wood stove be installed? * 'e."1-Cermanent occupancy
Central Air conditioning? x Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
RRanc' Contemporary Log cabin * • Other
Ra' ed ranch Mansion Duplex If addition, what will use be?
. Split level Old style Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ car
* * * * * * * * * * * * * * * * * * ' Private storage building
ESTIMATED MARKET VALUE OF *•'Other
CONSTRUCTION $ J3 5� * 'i ;` ,
•
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLE ED!
Form BPA 4/86 and-vl - .
4 .
BUILDING PERMIT APPLICATION CONTINUED - . ., t
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BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc.
Will any second-hand or ungraded lumber be used? If so, for what?
Foundation wall material I U is Thickness At-Cori L nb-
Depth of foundation below fade (to bottom of footin // 1�ivc}� I444 0_05 (Ay &vac
Will there be a cellar? z7 Heated or unheated? Floor sq. footage sq ft
Will there be a basement? Will any portion be used as living space?
(If so, what portion? sq.ft. .- - Type of use? .
Type of roof - sloped/flat/shed/other Material -of roof
Size, wood studs "X " spacing "o.c. length ft.
Joists(floor beams) 1st. floor "X " spacing "o.c. 'span ft. .
Joists (floor beams) 2nd. floor "X " spacing "o.c. span ft.
Overlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters . "X " spacing o.c. span ft.
Roof trusses(pre-engineered) spacing "o.c. span ft.
Exterior wall finish Of what material?
Interior wall finish •
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? ' If so will a Fire-rated
door, enclosure, and self-closing device be'provided?
-- Will a flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties ft.
(A separate application is ,necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT STATE OF NEW YORK
County of Warren
I swear that to the best of my knowledge and belief the statements contained
in this application, together- with the_ plans_and specifications submitted, are a true and
complete statement of all proposed work to be done 'on the described premises and that all
provi ions of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaining to
the p oposed work shall be complied with, whether specified or not, and that such work is
author ed by the owner.
SWORN TO FORE ME THIS Signature , = / / 42
1 -- -
Owner, owner's agefct,architect,contractor : .
day 19
Notary Public, Wa en County, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
•
By
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Application for: BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work.. ,
ANSWER ALL of the following: '
• 1. Gross floor area f (oC)
2 . Type of heat :1-41re
3 . Is the building mechanically cooled? �()
4 . Percentage of area of windows and doors
A. Over 16% O1,J
1 . Uo valu; of--gross area of walls , roof/c,e ' g and floors
exposed t• ambient conditions
2 . Floor over heate• paces ES NO
a. Are foundation . .- 11 insulated? YES NO
1.. If YES, what/i the R value?
3 . Slab on grade ,YES NO
a. If YES, what is the R valu- of insulation around
perimeter of floor?
Is ba-semen t heated? YES NO
a. R value of insulation
5' Type of insulation
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions .
2 . R value of exterior walls )&-\ Cr
3 . R value of glazed area /_ 5 a 4 (A//
4 . R value of doors - Z'-'
5. R value of floors over unheated spacesI
6. R value of slab edge insulation - unheated slab
7. R value of slab insulation - heated slab -
8. R value of heated basement/cellar walls (above grade) B-i3
9. R value of heated basement/cellar walls (below•grade) �
10 . Type of insulation J c?7 -C j -S A- \`oN-.mil
C. Controls
1 . Thermostat maximum heat setting
D. Duct Systems
1. Is duct system installed in unheated spaces? YES CO.
a. If YES, R value of duct installation
b. R value of duct in other areas -
E. Piping Insulation
1. Size of hot water or cooling carrying agent pipe
2. R value of pipe insulation
F. Service Water Heating
1 . Performance efficiency
- 2. Temperature control setting maximum .
G. For Swimming Pool Only
1. Maximum heating :-
Telephone No. 4
(applicant ' s signature)
•
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
!TEMP.# IDATE I ,
CITY OR ' ' i ��j�i -, f l rF _ r/�
VILLAGE ")1. , \ C t I. ._5 ( '. ;I ' TOWNSHIP (J.;,, 1:Al..r-) )-`jt"K.�l COUNTY W.,1 7� ' L: ..1•,
STREET AND NO.OR n, "}
ROAD AND POLE NO. i=S \ ;, ,--. •f--a,, -,:, -C, 7%. POLE NO.
BETWEEN WHAT TWO •_
CROSS STREETS IS - �� V. %_f _
PREMISES LOCATED? t!e :.a •,,v`,. v: C V{ ) 7 wv;e,!.i' SECTION BLOCK f LOT -- i
Y
OCCUPANT'S i 'f t 0 BUILDING 5, .-I r •
NAME \ 1i••��- `Y � 0 i,-.F.. OCCUPANCY 1;'),A)`t.-;L L.! .L)(,-) ----r '-;:-i: j-r r1.
I
OWNER'S NAME .--. �1,y ' s/•. ,' f` d TEL.#
AND ADDRESS k 1 1 k yv}(J i_l, Y VA, a,A f\,, `; 'j�.C.� `-)1".. ��fr 1 1
CURRENT
SU ,--
BY /�JF �/�- 6/ C. FROM THEIR �0 J-i__;ii_`� (--i `^ OFFICE
BUILDING / / ��11 WORK { DEFECTS
IS NEW❑ OLD l/11 IS NEW t. ADDITIONAL❑ REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No.oFixtures& BRANCH
NUMBER OF OUTLETS Lampf
fReceptacles MOTORS HEATERS CIRCUITS OFFICE USE
Loca- ONLY
tion Side Attach't H.P. Watts A.W.G.
Ceiling Wall Recap'Is Switch Pendant Bracket No. Type Each No. Each No. Gauge INSPECTION
Out-
side
Sub-
base
Base-
ment
1st Fl.
•
2nd Fl.
3rd Fl.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OF WORK. CONCEALED TRANSFORMERS OF VA
WORK TO BE (NUMBER) (CAPACITY)
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS
BUILDING OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE NEW III OLD
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES DATE OF rF /
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION Fr!_.. 3 "'� f,.,
PRINT NAME ANDrRESSt q
fe." pe' ----.) "--
NAME OF If i SIGNATURE
APPLICANT / `.'k�lit?/1 A/ ? ( OF APPLICANT � d
STREET ADDRESS Q! \ r.1.�( ler-I TELEPHONE# 7 ` ""j - 5'r,3 L�
CITY OR j (F f PO
'">f7rr( LICENSE NO.
POST OFFICE 1�,_t i �F'r?lt0- } ti'�U) I/Jut fl- CODE i a r.?"r S' WHENAPPLICABLE
46 EL (REV. 1/66) A SEPARATE APPLI?ATION MUST BE FILED FOR EACH SEPARATE BUILDING '
TOWN OF •QUEENSBURY A AL
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12801- _Se e
TELEPHONE (518) 792-5832 5111°
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED •�/‘/6
J /
NAME Q y�,w I cc r,
LOCATION , / !161- 0- 177/2 f 07,4t,
DATE 3/14 PERMIT # P6 - -�
/ /
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL.
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN •
INSULATION:
FOUNDATION
FLOORS. .
WALLS
/CEILING •
►/FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING -
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER(S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION /
.FINAL APPROVAL OF CONSTRUCTION V
OK TO ISSUE C/O OR C/C
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
//e_es
•
t,
ARRIVE /D (D
DEPART /0,16 ��
'vv 1/
INSPECTOR
INFORMATION FOR BUILDING DEPARTMENT
WE ARE IN THE PROCESS OF ISSUING A CERTIFICATE
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION
AS COVERED IN AN APPLICATION FILED WITH OUR
DISTRICT OFFICE.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
APPLICATION NO. 0,5- 'L C9"7
LOC TIO
DATE INSPECTOR
FORM IBD(REV.1/86)
Jown of Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAMEaZ/4.
•
LOCATION 4. (2& L
Date v'/7- /V' Permit N"o. p6�r'3jy
* * * *r* * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
'Roofing • (l k
aiding •
Masonry Vene
Rough Plumbin•.
Relief Valves
Porches
L.F1nished Floors
lXnterior Trim
. airs & Railings Q
Cellar Drain Tile
Concrete Floors
AP-Ibg. Fixtures
Lear. Fireproof' g Y/A
-Floor Closers
'Smoke Detectogs iD1.- A P/
Chimney
INSULATION: /
Foundation /
Floors
Walls
Ceiling
-INAL ELECTRICAL INSPECTION r�4{
DRIVEWAY APPROVAL O
LF4nal Bui'ding Survey
Next scheduled inspection (call when ready)
Remarks-
•
(4418
Building Inspector
6/86 and-vl
Jown of QuQenibur/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME 11111=4E-I
LOCATION . , , tb • i ,1,_____
Date/ /g7" Permit No. F4 -3r
* * * * * * * * * * * * * * * * * * * * * * *
= APPROVED -,YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill •
Framing
Roofing /
Siding
Masonry Veneer'
X,Rough Plumbing Se 1 D Cj 1.-Relief Valves
1
Ext. Porches
Finished Floors
Interior Trim
Stairs & Raili'.s
Cellar Drain ^ile
Concrete Flo.rs �-
X Plbg. Fixtu res als
Gar. Firep..ofing
Door Clos s
Smoke Det •ctors
Chimney
•
INSULATI )N:
Foundation
•
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled ins ection (call when ready)
Rema -
exr4zA1A -.c F U rrPttL w —
2-0 cv-67. .46-vGL /h r(c Af(s 'W,1).f
rsN
Buildi V Ins ec
6/86 and-vl
G'/C;&4 c��L1)6-1.L('A,
Down of QUeens b urty
, j BUILDING and ZONING DEPARTMENT
� )r Bay and Haviland Road, R.D. 1 Box 98
//c/
Queensbury, New York 12801
•
BUILDING INSPECTOR ' S REPORT
NAME /1/1A-c)q
LOCATION
— C L
LA)) 144-
Date !/e / F 7 Permit No. Vo - 31
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing 11..()fl O_S( re: (////:-
-
X Backfill 0,C. i
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing N
Relief Valves \ /
Ext. Porches \ f
Finished Floors \ I
Interior Trim \
Stairs &__Rail ings . � ,
Cellar Drain Tile
Concrete Floors a :
Plbg. Fixtures '\
Gar. Fireproofing N
Door Closers
Smoke Detectors f
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey r
Next scheduled inspection (call when ready)
Remarks-
:"--- '1(_.
i
uilding Inv ector
6/86 and-vl
cc77
awn of QUeenitury
BUILDING and ZONING DEPARTMENT
Qay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME PA-V L fr/A-C-/2—I
LOCATION C V LA-I<
eQ W_Date a2- Z9/ g Pe'� Permit No. b .�Y--
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
(Fo in /Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
_Stairs & Railings
\ ////
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures /
Gar. Fireproofing Y .
Door Closers / \
Smoke Detectors /
Chimney / \\
INSULATION:
Foundation
Floors \J
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks- y atil
Aills
Bui ding In//1.-::°4spector
6/86 and-vl
_locun o/ Quenitur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION /1/4AMS Iti1rz reAt
Date /274/ (et Permit No. Y(o ,- k31
✓ = APPROVED - YF,S' / NO
)(Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile.
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
t
Next scheduled inspection (call when ready)
Remarks- ( /) ^l! nrr
Building Inspe to
6/86 and-vl
Down of cu?eni4ur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
I
NAME PA,Le L R6 Glrl
LOCATION (aJuu S 1 &V
DATE 3 / PERMIT NO. S(vi, �83'
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel ;
SEEPAGE PITS{Number of) T�,'
Size- ft. X ft. 47\
Gravel size / \
PIPING: Sim. Tye
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: 3/8-_Svc 9651-0 Cc(-d-e/C --o t5
T/-i-4) 130 x I ,.J-s^ Go
/10-r P O (j`%
IV I✓o wz744&))/Lt E2)4Af-f2-1 /Vo -t ho
A-N`F Po rr.--r'I OA)O f-S-,STds-,(1
13 f oR%- 1 NS PGar oAf'-
SYSTEM USE APPROVED YES
Bui ding In pe tor
01/86 and vl
ETZGEN MASTER FORM 198MF
i
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a
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•. l
ZGEN MASTER FORM 198MF `
DIETZGEN MASTER FORM 198MF