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8433 • • • ' BUILDING PERMIT • jI TOWN' OF QUEENSBURY. 8433 No. • WARREN COUNTY NEWYORK PERMISSION is hereby granted to Walter Dombek (Real Estate Office) 'rt ' n ,OWNER of property located at south side .Quaker Road . Street, Road or Ave.' •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 -approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. . 1. OWNER'S Address is Rt. 9N P. 0. Box 649 Lake George,- New York • 2. CONTRACTOR or BUILDER'S Name Dale Granger and Sons 3. CONTRACTOR or BUILDER'S dr 1� homer Ave. Glens Falls, New York 4. ARCHITECT'S Name IDi • O 5. ARCHITECT'S Address • • 6. TYPE of Construction—(Please indicate by X) - ( )Wood Frame ( ) Masonry ( )Steel ( ) - 7. PLANS and Specifications No. Wisconsin mound . system per plot plan and ' application submitted. m • 8. Proposed Use , • Iv _ �4 (D Sewage .system for commercial use. • (Dd. m • K $ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 26- 19 86 w . - (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the N O town of Queensbury before the expiration date.) � • •Dated at the Town of Queensbury this 26th Day of April 19 84 • SIGNED BY aI £2 aZa,cw for the town of Queensbury Building and Zoning Inspect° TOWN OF QUEENbesU rs 5 5 Z TOWN OF QUEFNSBURY E C E II V E BUILDING & ZONING DEPARTMENT SEWAGF DISPOSAL PERMIT APPLICATION An 1984 jo 1. Owner ' s Name weliA.„ 7)8)91Z l)12)zP)3) )M Address Q+ 7 L C�. �� y Telephone No. 993- g e C� 2. Property location c9ueA �LQ , 1p6„zt., NET r2- o 3.. . . Name of person or firm,.responsible for installing system CY 1�v�Gq/ir`� � S Telephone No. 7 2—Q 6Z 7 Address ?d1_ j� t' 0 i- 4. Number of bedrooms (residential buildings only) 5. Daily flow ? gallons/day 6. Septic tank capacity , jam gallons 7 . Topography: glik rolling., steep % of slope 8. Nature of soil and depth (Q41i 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 43 4,8,.1,..44.,,` Eck 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 varie from the approved application will be subject to a penalty of $250 as pr ided for Section 6 .010 of.. the Queensbury Sanitary Sewage Ordinance. . • Date 4/2, 3 /g ALL, signature of a licant 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. i S COYr Sir, {'h° Sys rep', Form 3-82 fe eSTetT, © Ss- cz sour' S + dk Qif I h-evr Co en i e•„2r Fo 0,1 Mari , \ , let / kxs 1:::(44 1/ 1-a* Ic 7 ___, -s" • I 1 \ i I ( I 1 - I ‘;01.. I r 1.‘ I ''' ' ) 1' 1 7 I ,..3... c i ) i , N. I I 16 ,D - 1 r - ,\ I , \ \ i - ___---- - - i .E, . e ,.: . II?,