8384 NERMIT
TOWN OF Go UEENS�URP Y No. 8384
. WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Queensbury Post No. 6196 VFW
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OWNER of property located at Luz erne Road and Richardson St. Street, Road or Ave. 3
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in the Town of Queensbury,To Construct or place a Sewage Alteration
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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. rly
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1. OWNER'S Address is Luzerne Road
Glens Falls, New York Z
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2. CONTRACTOR or BUILDER'S Name Reliable Sewer Service
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Carl Dingman o)
3. CONTRACTOR or BUILDER'S Address
RD 4 Luzerne Road
Glens Falls, New York
4. ARCHITECT'S Name
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5. ARCHITECT'S Address (D
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) P'
7. PLANS and Specifications ()
1000 gallon tank, dist. box and 2 7 'x8 ' drywells
No. per plot plan and application submitted. a
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8.-Proposed Use 0
Sewage system for VFW Post C0
$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 6 1986 -
(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 6th Day of April, 1984
SIGNED BY "71,1 G Cd•- mil_ is> for the Town of Queensbury
Building and Zoning Inspector `� (D
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o 3 _ r TOWN OF QUEFNSBURY TOWN OF QUEENSBURY
'r . 6 BUILDING & ZONING DEPARTMENT R [ [ [j I
SEWAGF DISPOSAL PERMIT APPLICATION IT
( u e eh s,"`" APR 61984
1. Owner ' s Name ' f/ ,r, w oS a_M. /40 /= P Ma
S 71 11 41121MMIgl6
Address ). ri C, i
Telephone No.
2. Property location L 4.34?„y n €, 173
3 . Name of person or firm responsible for installing system
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/S PX�-a .Q, � z • Telephone No. 7 F.2 - f S
Address il t c e,7._,, ,,�, ,
4. Number of bedrooms (residential buildings only)
5. Daily flow gallons/day
6. Septic tank capacity 2000 gallons
7. Topography: flat, rolling, steep
% of slope Pi q
8 . Nature of soil and depth r,, u
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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 minutes/inch
11. Water supply: municipal well, other
12.. Type of system proposed: drywell, tile field, other �q
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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
> , Queensbury Sanitary Sewage Ordinance. ,
Date ��
signature ofArtErant_
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions, including distance from anyy structure, distance from
property line and domestic water supply, etc. Include all dimensions of
the system itself.
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Form 3-82 a 7° u' e 11 s
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