8234 •
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• . BUILDING PERMIT
TOWN OF QUEENSBURY '
No. 8234
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Pizza Hut
lessee - ro
OIof property located at Route 9, Miller Hill Street, Road or Ave. I-'•
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in the Town of Queensbury,To Construct or place a Sewage Alt.
• 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. ri-
1. OWNER'S Address is
Route 9, Miller Hill Herbert G. Sheinberg
Glens Falls, New York P. O. ' Box 428
Wichita, Ka. 67207
2. CONTRACTOR or BUILDER'S Name
Dale Granger and Sons
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3. CONTRACTOR or BUILDER'S Address
- ct
14 Homer Avenue m
Glens Falls, New York
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )•
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7. PLANS and Specifications
sewage alteration per plot plan and application
No. submitted. •
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8. Proposed Use la)
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Sewage system for restaurantrt-
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 17 19 85 lv
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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 0
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 17th Day/ of November 19 83
SIGNED BY Jf'l46 - Q- for the Town of Queensbury
Building and Zoning Inspector l j'r
�/► rr TOWN OF QUEENSBURY
°'° - V1 BUILDING & ZONING DEPARTMEN !'TC9l /6� ®F C�LdEEt�S�41RY
1 WAGE DISPOSAL PERMIT APPLICA ! � �iNE 0 E Il 'V E '
1. Owner' s Name 'P.? b .�,, „NOV I .ta 1983
Address ?OMl;o1iiw) n21314J5i6
p
yii11'l�} 6 ,A. tv.),Ar GI CIF (2 Telephone No `-q ,il11
2. Property lo` ration 9XtiJe-q\
3 . Name of person or firm responsible for installing system
b ► /moo AMA/4 2-ALA Telephone No.7 '®6 4 R 7
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Address .t . •
4. Number of bedrooms (residential buildings only)
•5. Daily flow 5-1
gallons/day
6. Septic tank capacity gallons
7.. Topography: lat, olling, steep
- of slope
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8 . Nature of soil and depth ,
9. If ground water, bedrock or impervious material is apparent . at what
00-
depth does it begin? IA 5-h ft. . -
- 10. Percolation test: ' A . is required
,, B is not required
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C required what is the rates.,‘ minutes/inch .
11. Water supply: municipal well, other
12. _ Type of system proposed:- drywell, tile- field, other p s, ,
Anycontractor, corporation, � �
,. p , individual,. etc., engaged. in const uc.tion
of -a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies f (sm the approved application
- will be subject to a. penalty. of $250 as provio -d for. in Se ion 6 . 010 of the
Queensbury Sa ita y Sewage Ordinance.
. Date t / / i
P signature ofeapplicanit -
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, etc. Include all dimensions of '
the system itself.
Form 3-82
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