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1988-682 . • ; t, . „ • _ 4 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date November 28 19 88 This is to certify that work requested to be done as shown by Permit No. 88-682 has been completed. This structure may be occupied as a One Family Mobile Home Location Le Howard Street Owner Joan Waters By Order Town Board TOWN OF QUEENSBURY1 / Building & Zoning inspector . , BUILDING PERMIT TOWN OF QUEENSBURY w No. 88-682 WARREN COUNTY, NEW YORK N PERMISSION is hereby granted to Joan Waters `cp OWNER of property located at Howard Street Street, Road or Ave. u, in the Town of Queensbury,To Construct or place a Mobile Home 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 51 Michael Road Fort Edward, New York 2. CONTRACTOR or BUILDER'S Name ts1 cn Todays Modern 0 3. CONTRACTOR or BUILDER'S Address A' 54 XX RT.9 Gansevoort,New York 4. ARCHITECT'S Name 5. ARCHITECT'S Address x 0 n a. 6. TYPE of Construction— (Please indicate by X) cn rt rt ( )Wood Frame ( I Masonry ( )Steel ( ) m rt 7. PLANS and Specifications No. 24' x 52' Mobile XXXXX Home as per plot plan and application, including septic. 8. Proposed Use One Family Dwelling/ Mobile Home $ 25:OOc/o PERMIT FEE PAID —THIS PERMIT EXPIRES April 1 19 89 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 0 town of Queensbury before the expiration date.) N co Dated at the Town of Queensbury this 9th Day of September 19 88 SIGNED BY /-C for the Town of Queensbury Buil iinngg and Zoning I sector • Z0 D1~ COMPLETED LW BLOC. DEPT. • --0','- .OF.01JEE.F°;._ 's7' x - Q - . - uwo. oi ur� Application No. - u'1 ,`� DUILUI J Permit Issued • lg n NG �nd.ZONINC OEPAfiTMENT �; . Day Lind Haviland 'fload;R.D. 1 Box 00 Poring Designation- _' •it• Oueenstury, New York 121301 ,. Zoning a No.. anon_ SEP Variance Ho. ad-�-�� Site. Plan Review . . BCiIC.1:DiNG 8c COODE DEPT. /•� � _. APPLICATION FOR • Approved/ )"1(r,- -O , j:,tlat. -llp, MOB I'LE HOME I'UILDLNG AND ZONING '�� ��; . PERMIT. - - * I „* • I' • ! * . * • • * • it • * •. * x" * A '* fly' *'`it'''* *::•' 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 uubiuitt):d '`and ;such .' ... ::pecial ,conditions au- may be indicated on the' Permit. - The owner, of this property is: For t��' ,,ve- N.V -Tel. 79631-//sy Property Locationi` aJj�� �' / 41.'E S<s2..�7� • Tax Ma e.`1�1 Street. l,wIbLr or building lot number P W 120' S • Subdivision name (if applicable) ' • TILE PERSON RESPONSIBLE FOR SUPERVISION OF. WORK AS REGARDS DUILDINC CODES IS: Name P.O. AddreSa Tel No., - ,Name of Installer s, �.: Name o1' Ins tar �, ___Address s:Vi 5, C .1.... set/�� ,// el. Address 1U 7jB �/D3 - . . ;. N:,i,K of u�,uon• Tel. Addreuu MOD I LL•' HOME INFORMATION: •- • ZONING INFOR ATION: • New -Nome Placement" .S •^ �`LC tlq PLOT .PLANSMUST DE PREPARED. AND SUUMITPED � Replacing existing Home drawn reasonably to scale and attached hereto;' ""'�.'�' showing clearly,and distinctly building di' .1. _.-a:::::Size of new Home ►• y :all. bulldin 5``' •_. o'?/•ft X Z_ft • • whether existing. or- proposed'and 'indicate all' '- ' ' Single w:le Double .wide• X, sot-back dimension . .f.rotn„property lines. `Give ''.''" street an_ u d_nnbe_r o.r-lotand'13i-dicat� " ' - No.: of rooms (excluding-iuding-baths-)-• _,5" tither Jint:erior ci'r• corner'.lot.• Show location: No. of bedrooms. ' • '` of voter supply and :location and' cgnficju,rution ` of peptic disposal area No. of bathrooms. w �:\:;�.-` ~- - r COMPLETE INFORMATION REQUIREDfiEL04.,{ Fireplace? Wood stove? • 4= ' Size of property ' ~: - Foundation style CEO � �" f t X =f t:. • Y and ize: �, " Existing building r Pi �''�v �-.-' . . . gla) Size - - _fr _X ;fE lxiatiny building (Li) Use = _ Depth .4.elow.grade . ft. ' • ---L- FOUNDATIONPootirig size X �� •':. 1.1. •1 ropouud building, disLancu from property line Wall material . -Front yard of0 ft Roar yard iZ ft • , Side yards /�Y ft and tY 3 ft Wall thickncss " Height ft. . If on cofner, setback from aides attest ft • Total depth below. gr•ade ft. ••' OCCUPANCY INFORMATICN • Grade to •Itomo floor level 12=30 ft. '•• •. . PRIMARY BUILDING - • a a ` *' * . * * * • .a, . . . . . . * * „ Ono family dwelling . Proposed date of placement j`0/ /0 ' Two family dwelling • . Multiple dwelling / Number of units Aprox. Value, of-.Home $ r __Permanent Occupancy.. nv v Water upply - We Municipal " Transient occupancy . Ilusineus '• Industrial Septic Permit required? 4 l7/lG/ e * other • • , If addition, what will use be? • • FURTHER INFORMATION REQUESTED ` ON THE, REVERSE SLDE OF THIS SHEET.* ACCESSORY BUILDING- Detached garage/one car/ two car/,_�ar ' Attached w garage/one car/ two car/ car ____Private storage building . a other Form M11P 5/136 and-vl e • • APPLICATION FOR' .MOBILE HOME PERMIT, (CONTINUED) . State of New York Division of !lousing and Commu' INSIGNIA OF APN►cOVAL OF THE STATE . BUILDING• ' i� �� �1?z� l•ClC tin[ l ML IS K . INSIGNIA SERIAL NUMBER P ��� ? . NAME OF MANUFACTURER • • `S . PLAN APPROVAL NUMBER . MODEL . OR COMPONENT DESIGNATION • • • > . MANUFACTURER' S, SERIAL NUMBER i . DATE OF MANUFACTURE • . • • All the above information is to be found on 'a plate or sticker which :hould be affixed to the Mobile Home. Complete..above with that information. • (4 4 4 4 4 4 4 , 4 4 4 4 4 4 4 4 4 4 4 ••4 4 •4 ••4 ' 4 4 4 4 4 , 4 4 4 4 4 4 4 4 4 4 `town of Queenabury . County of Warren A F F I D A V . I . T STATE OF NEW YORK • I swear that to the best of my knowledge : and belief the statements contained in this application, together with the plena and specifications submitted, are a true and compldce statement of all proposed work to be done on the described premises and that all provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all other lawu pertaining to the proposed work shall be complied with, whether specified or not, and that su h work is authorized by the owner. • .44 Signature r c. , ' o ner's agent,�rcnitect, on rector • Niit?CJ a't3lSt' . �' = lit-ftc, 71,1 • • • y • • • • e * . r a • r '� SPECIAL CONDITION 11i_. PERMIT sS, E • • • • • • • • • . By . • • • • • • • • • • •• •Yrurlt of aet1146ill APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE 9 79 018 LOCATION OF PROPERTY FOR INSTALLATION 11-0 D' Owner's Name: (9 v4/i1762.S Telephone: jqd- //�y .- Address: �� i_///_C// 0 ?r. C—p�✓'p// /� / (zg ,. Installer's Name:-YAW 1TS-12 SPLcfPK.. Telephone: '' 7 eid -.7d-c$-9 Number of bedrooms (residential only) _K 3 Total daily flow (compute @ 150 gal per bedroom) c-5-0 Topography: circle one Flat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: :. feet Ground Water: At what depth? feet Bedrock-or Impervious Material: At what depth? `— feet Percolation test: circle one(t require required /rate min. inch. Domestic water supply: circle on Municipaaa Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank /00 0 gal. (minimum size: ;1,000 gal.) TILE FIELD: Each Trench — feet / Total system length feet SEEPAGE PIT(S): Number of _2,— / Size each (o feet by feet Size of stone to be used # / Depth or Thickness Z_ feet * r * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 1 IMPORTANT ...Please...LIST NEW EQUIPMENT TO BE INSTALLED * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * / Gov 94/Ion sep:7 G V/S'Terb v;fo,ti eu . G ' x� ' Tv“ oie(/Y— (over) Section II Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing: 1.) the proposed location of the system ` 2.) location and distance to lot lines 3.) location and distance to structures - • 4.) location and distance to any water-supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywells B. No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $250.00. • C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may,result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, • alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above .1$ I agr- - to abide by t i . - and all requirements of the Town of Queensbury San' . Sewag-.Disposal • ',inane:. Signature of responsible person: A1 A c?! eg Date: • Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 . (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAI RFAIITv A _ - • •• INTERIM BUILDING PERMIT PERMIT APPLICANT m Ojeda-S. CONSTRUCTION LOCATION /1766,,,owd EFFECTIVE DATE Cj 74 .10 APPROVED BY r1,11 7 's'� � SPECIAL CONDITIONS : This will certify that all submittals for a Building Permit have been received and fee has been paid . During the processing of the Permit , the above named may begin construction per plans submitted . It is the responsibility of the applicant to obtain the Permit from the Building Department, following pro essing . POST THIS INTERIM PERMIT IN A CONS CUQU'S OC1TiON7! ! /7/7 • • V‘...:0„," -- Building & Codes Department . TOWN OF QUEENSBURY REQUIRED INSPECTIONS: 24 HOURS NOTICE REQUIRED!! 1. Foundations Footings, before pouring concrete. • 2. Foundations Inspections and Waterproofing, before Backfill. 3. Rough Plumbing, heating and Frame Inspections before Closing in the Framework. 4. Insulation - Foundation, Floors, Walls, Ceiling. 5. Inspection of Electrical Installations before covering (rough in) and on completion of job. Final inspection certificate is necessary for issuance of CERTIFICATE OF OCCUPANCY. 6. All new septic systems or repairs before covering any work. 7. Final Inspections before Certificate of Occupancy is issued. THERE IS TO BE NO OCCUPANCY OF 'TIE BUILDING WITHOUT APPROVAL OF THE BUILDING DEPARTMENT. • V L• U U U V U , \—)' ' 48EL(REv.vee) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATEBUILDING THE NEW YORK.BOARD OF FIRE UNDERWRITERS .' C.EFrT. ICATENO• ;' r-DO NOT WJ3ITE HERS FOR OFFICE USE ONLY to:..* BUILDING PERMIT NO. >.' yp r. �yy'V., t ,,,,, .„ I r�' Y ". TEMP.a vt4V • ,ih ,•s, .y s l .. .. DATE /��' . CITY OR VILLAGE�!� •• • . TOWNSIIIP •! `f'v GG4/.S,CjiJ2 y �/1J' Zic% • :... STREET AND NO.O ROAD P•OLE NUMBER Aw/ O S 7 r .. - BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED?:• SECTION . - BLOCK 1 ,.LOT • • c--c_.61:as;c7vt-,,,..4 '_-•$lf 'r1.4--J t 4-626y-�.,✓✓'J OCCUPANT NAME ' BUILDING OCCUPANCY t. . OWNER'S NAME AND ADDRESS p HOME TLEPI •.E NUMBEA' `,• • LTD Pr'')•. GtP1--le/2S •off /lc/ia.e/e� c' �z�r, ,ex, .? J 44--. . _• CURRENT SUPPLIED BY 4••� I J /l FROM•THEIR OFFICE : WORK TELEPHONE NUMBER,•• ' •' •• V/ V .. BUILDING IS • - .• . NEW AtD)/lF //v' 'l LD❑ , WORK IS NEW 0 ADDITIONAL O. DEFECTS REMOVED❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED: • • ' NUMBER OF OUTLETS No..of Fixtures& MOTORS HEATERS > OEFICEUSE :• • tDCa- BRANCH , `� lion Lam Receptacles a �f ` Side Allach't p P CIRCUITS t "' x'��`'" Ceilin H.P. Watts • A.W.G. ,x : ' „,�ONLI xr. sy, g Wall Rocop'Is Switch Pendant Bracket No. Typo No. No. '_`''`••`� ��`•'� " '�'�'r�f.5,• a n n s 7• dM:. OUT- Each . Each Gauge =:.; t0INSP.ECTI0NVv.:`"..'i `'` SIDE ih it;:, ?�rI�,i{ chi z_ ''' • SUB_ • _• -- a :?i,:n.• ,r:, BASE .In. 5'?`ii3;a?�i�t'4; ;'�y",�^y'^t . B�LSE- — •:.5,•'•: ip,°rti>:411":i.`f�;' T1. MENT • ••' ' .z - • r r r 'w• r., .FL. I ,s7,r y rv,: 4 2nd .. r Y rr u'ts•.r. , ..a�•k=� t . FL. .. . Svfia?tk '.ti:wy.; aXr s'=.;�r -. f 1 7' �?,'�.�' • REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: _,.f,. �,Y?,,,Ti1j ,l �'Jr • • THIS APPLICATIONIS INTENDED.TO COVER TFIE•ABOVE-LISTED EQUIPMENT TO BE INSPECTED,BUT IF AT TIME OF INSPECTION,THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND-ADJUST.THE FEE TO COVER- THE ADDITIONAL EQUIPMENT,AS PROVIDED BY THE APPLICANT. - SIZE OF MAINS. ' FEEDERS ELECTRIC SIGNS/LAMPS 1' "' • . TOTAL W,VTS. CHARACTER OF WORK GA,TUBE SIGN/TRANSFORMERS OF❑ EXPOSED W ❑ CONCEALED ' DATE WORK TO BE • DATE COMPLETED SIZE OF SIGN(NUMBER)'r . • CAPACRY ' SERVICE ENTERS BUILDING • MANUFACTURER OF SIGN 0 OVERHEAD ❑ UNDERGROUND - _ DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) ' . • MUST ENTER APPLICANTSYr`;r It ° tip"'I`:7 '!ti'=' �1: 2t F< : `IDENTIFICATION NUMBER%; =`,k.:4..:7t:$h?�;�;.;;; ` ,,;,•: ;'t ?:i: •• �• "' AVOID DELAYS BY GIVING FULL'AND ACCURATE.INFORMATION.ALL SPACES MUST BE FILLED'IN OR'APPLICATION MAY BERETURNED.� • '•' I' PRINT N• E AND ADDRESS NAME4 •• j, \ —� - DATE AP LICATION .•SIGNATURE.OF,APICAN 7•4 rrr .:�;' /lip_/ e .SD,. / F..., SIRE AiD• Si e' X. i.6;;.:e.:St;cq?s4'•.(:.. yy,, t•° F • .TELEPHONE NO..' • ' CI r OR POST O" ICE • ' • : ZIP CODE LICENSE NO.WHEN APPLICABLE • 0 85 John Street ❑ 41 State Street ❑ 584 Delaware Avenue Q.217-Lake Avenue :: • • ❑ 202 Arterial Road. NEW YORK,NY 10038 ALBANY,NY 12207 BUFFALO, NY 14202 ROCHESTER,NY-14608' SYRACUSE:NY 13206 THE NEW YORK BOARD OF FIRE UNDERWRITERS . BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED. • awn of Queenitur, BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME 4.\Jr. S. LOCATION LOT 3 2 -0-v DATE //? i f PERMIT NO. 6g9 SOIL TYPE - Sand Loam - Clay - j Percolation es Required? YES NO Percolation rate - Min/Inch - r r TYPE of SYSTEM: Absor tion field, total length/ �� Length of each trench /00/ Depth of trenche� f2'' if • Size of�\gravel ,�j SEEPAGE 'PITS{Number of) ' / Size- 'Aft. X ft. / Gravel size , / PIPING: Size T e Bldg. to tank 1G Tank to dist. box / / li w� • Dist. box to field • N Openings sealed?, NO Partial LOCATION/SEPARATIONS: Foundation to tankr,, /Oft. Foundation to absorption 2$)ft. Absorption to lot/ line /O ft. Separation of pips ft. LOCATIONSTrEM ON PROPERTY(circle one) Front - Rear ,, eft side 7Right side - COMMENTS: t Z , SYSTEM USE APPROVED ES NO Building I s ector 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801- TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED NAME „/)•�5 Jr LOCATION 1f.?d 32 //i?4/�✓ ✓S (� DATE //9/ PERMIT # ff.-6YR APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS ✓FOUNDATION/DAMP-PROOFING ./ L,SACKFILL PPROVAL ,r' ROUGH PLU1 ING FRAMING ELECTRICAL R UGH-IN /s. INSULATION. y, FOUNDATION .;,' ' FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT . ,0' ROOFING „{t SIDING EXTERNAL PORCHES/S PS STAIRS-CLEARANCE'`& ILS PLUMBING FIXTURES/REL EF VALVE INTERIOR TRIM/PRIVACY' DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER(S) ;;\ SMOKE DETECTORS FINAL ELECTRICAL INSPECTION'\ FINAL AP/OVAL OF CONSTRUCTIO A SIGN$D CERTIFICATE OF OCCUPAN&Y MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: " /emu 64°Q--- P/C y 4410 iti �,�s� crij/ AA% I PECTOR TOWN OF* QUEENSBURY BUILDING AND CODES DEPARTMENT 6?)///77 BAY & HAVILAND ROADS /./ QUEENSBURY, NEW YORK 12801 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED ��"__ NAME s;?-i-ra_41) 11/2-6z-- LOCATION 74/6'-U.dGLJLGG- . n / !r� DATE /V - cg(� PERMIT # S - ()? APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS /,'' WALLS CEILING \ti ANAL INSPECTION: ' /i CHIMNEY HEIGHT '' ,A /1 ROOFING 1V 1.7 SIDING Z EXTERNAL PORCHES/STEPS\ STAIRS-CLEARANCE& RAZE PLUMBING FIXTURES/RELIEF VALVE l/ INTERIOR TRIM PRIVACY DOORS t/ FINISHED FLOORS r/ GARAGE FIREPROOFING rt DOOR CLOSE3(S) ‘y\t-I)P^ SMOKE DETECTORS FINAL ELECTRICAL INSPECTION \1 FINAL APPROVAL OF CONSTRUCTION; A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: • P-i 2 S Liu- c� © • Q\. INSPE OR 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• -7 1 P t 5� LOC TION .1f , z? /PE a9t,t-vjfrrz, DA E INSPECTOR /AA\ -- -'- -- TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED // e NAME fr-A9---d-42.-- /(AtaG7 LOCATIO //6-(,(j6 DATE /A //- PERMIT # / - / t? 2 , / � f APPROVED , y..�� �/ YES NO FdOTING/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 A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED!• REMARKS: r , (,, ,L- , ._ SLR NSPECTOR /(/ S • awn of Queeniur, BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 ' Queensbury, New York 12801 SEPTI DI �PQSAL SYSTEM INSPECTION NAME � ,��I a LOCATION / ,Vfr/ 57 , , DATE O/3/ PERMIT NO. 4'1 ,f (Q d SOIL TYPE - Sand - Loam - Cl y - Percolation Test Required? ES - NO Percolation rate - Min/Inch TYPE of\SYSTEM: • Absorption field, total le,gth Length oach trench Depth of trenches ' Size of gra�4,e1 _ SEEPAGE VITS4Number..of) ' 7 Size- g ft. \x i' ft. ,j— Z Gravel size , \ --7-i PIPING: \ Size Type Bldg. to tank \ i,( /9 VC__ Tank to dist. box\ /-' Dist. box to fieldi:t-- ,1/ p vQ-- Openings sealed? ES NO Partial 1/4 LOCATION/SEPARATI' S:`, Foundation to tan / 'ft. Foundation to ab-orptio t-<' Et. Absorption to to line ..-4 ft. Separation of p' s -.Z_ft. LOCATION,OF SYS EM ON. 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