8242 •
BUILDING PERMIT
TOWN , OF QUEENSBURY -
- No. 8242
. WARREN-COUNTY,NEW YORK
PERMISSION is hereby granted'to Daniel Jones
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OWNER of property located at 12, 1� U • Lake. Parkway, .Assem• bly Point Street, Road or Ave. H
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 in
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance..
1. OWNER'S Address is R. D. #1 •
• Lake George, New York '
2. CONTRACTOR or BUILDER'S Name
Edward P. Carr, Jr. • ti
3. CONTRACTOR or BUILDER'S Address . Iv
244. B RD, #1 • m
Lake George, New York . b
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4. ARCHITECT'S Name • x
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5. ARCHITECT'S.Address . N
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- -6. TYPE of Construction—(Please indicate by X) ` 1•4
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( )Wood Frame ( I Masonry ( )Steel ( ) O
7. PLANS and Specifications
1000 gallon septic tank; ..pumping tank
No. , _ 270 ft. tile field per plot plan .and
application "submitted.
. 8. Proposed Use
Sewage system for .dwellingcn
10. 00m
$ PERMIT FEE PAID—THIS PERMIT EXPIRES November 18 19 85 >I
(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.) fi'
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Dated at the Town of Queensburythis . y Iv
18th. Da of November 19 83 rt
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SIGNED BY 2 7 ad a• w 0 for the Town of Queensbury - -
Building and Zoning Inspector "
TOWN OF QUEFNSBURY
BUILDING & ZONING DEPARTMENT cG
I - TOF��lt�9 Cry ������
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! SEWAGE DISPOSAL PERMIT APPLICATION E V
1. Owner's Name Mr. Dan Jones rsicni ,.
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Address RD #1 Lake George, N.Y. 12845 AM; h � _. , � A' g
7181• y110111112411 o 1 Q,L=e 6 �„
Telephone No. g,
" 2. Property location assembly Pt. N.Y. L. �e e P arl-
3. Name of person or firm responsible for 'installing system
:Edward P. Oarr Jr. Telephone No. 793-0941
Address 244 B RD #1 Lake George N.Y 12845
4. . ' Number of bedrooms (residential buildings only) Three
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5. • Daily flow gallons/day
6. Septic tank capacity 1000 gallons
7: Topography: , rolling, steep . .
% .f slope..
8. Nature of soil ,and .depth Clay4 10 '' Hardpan
9. If ground water, bedrock or impervious material is apparent at what.
depth does it begin? ft.
10. Percolation test: A is required
B is not required
• C If required what is the rate 18 minutes/inch
11. Water supply: municipal, well, other Lake George -
12. Type of system 'proposed: drywell, tile 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 applicatiion,<-
will. be subject to .a •`penalty of $250 as ovided f 'n Section `6 .01.0.. of._.the.
Queensbury` Sanitary Sewage Ordinance. .
Date October _20 v 1983 .`f signature of applicant
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
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Form 3-82
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GENERAL CONTRACTOR
-• 2.4413 RD#1
LAKE GEORGE,NEW YORK 12845
(518)793-0941
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