8424 BUILDING PERMIT
TOWN OF QUEENSBURY 8424
No.
WARREN COUNTY, NEW YORK
w
PERMISSION is hereby granted to Samuel Gottlieb 5
(D
25 Centennial Drive ~
OWNER of property located at Street, Road or Ave.
0
in the Town of Queensbury,To Construct or place a Sewage Alteration ct
rt
at the above location in accordance to application together with plot plans and other information hereto filed and N
N
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. C
b'
1. OWNER'S Address is 33 Reed V lvd.
Mill Valley, Calif. 94941
2. CONTRACTOR or BUILDER'S Name Daniel Drellos
Sanitary Sewer Service
n
ID
3. CONTRACTOR or BUILDER'S Address rt
53 Fourth Street
Glens Falls, New York ;"3
w
H
4. ARCHITECT'S Name
t7
Fi
F,.
•
fD
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( ►Steel ( )
7. PLANS and Specifications dist. box and 2 8 'X8 ' drywells per
No plot plan and application submitted.
8. Proposed Use
(D
Sewage system for dwelling
0
$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 24 19 86 fi
(If a longer period is required an application for an extension must be made to the Building and Zoninginspector of the N
�i
town of Queensbury before the expiration date.) p�
rf•
Dated at the Town of Queensbury this 2 4 th Day of April 19 84 O
`� ,e
SIGNED BY /�G�G' /6y for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEFNSBURY
BUILDING & ZONING DEPARTMENT /
P _ ) - .� SEWAGE DISPOSAL PERMIT APPLICATION /� e
1. Owner ' s .Name SA j(4 U' e,(_ Gorr-Lit 6 I/
Address _33 en / : / jj /"l ( 4 l WA!"t-e , .AL/-. q'494 .(
Telephone No. ' /S'- 9, '- /91 -a-
2. Property location FS (7. , J j ej'AJ C .
3 . Na of person or firm res onsible for installing system
/t) f J' CUa . Jf/fcJ(v- Telephone No. 7oL 701-47,.
Address /Qv 700 S/ -
4. Number of bedrooms (residential buildings only) TOWSOF QUEENSBURY
5. Daily flow S0 0 i` IE V. L!gallons :a`j3711 V E 0
6. Septic tank capacity / CO CD . PR 1 1984 gal o s
AM. , ld #' fZ'"
G
: 41EWtPeav P1L7. Topography rolling, steep ?18,91111112131416
aaa
1
% of slope -
8. Nature of soil and depth cD /40
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ft.
10. Percolation test: A X is required
B is not required
C If required what is the rate &-'S minutes/inch
11. Water supply: cnicipal, well, other
12. Type of system proposed: ETYr2j) the 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 application
will be subject to a penalty of $250 as provided for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance. .
Date '/ /
9-- FC 1. 0 c-d,i0 2x_k,0/,--L_
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.
,,2, p x Doty w s'
----1 _ 7)/; ( ‘ i / J /J '7tj)c
Form 3-82
TOWN OF QUEENSBURY
Building Department
Inspectors Repast Date
Name (-)ilZ .1i
Location
Permit No. br• r/ Weather
Remarks
Excat'ation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst. l
Septic Approval
ic
Floors
Insulation Foundation
Walls
'Ceiling
ifadd' „zw._/ t)
Building Inspector
REMARKS
-sb/&
x 8 ,
SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N.Y. 12801
TELEPHONE 792-7257
})--j PAil/r(1---: 1
J✓ qm}
r �1 lS1M.
t\,....\„‘N____),_,,,
0 '71C1d
1 ! '.
0 1"0I
: - / :
I:I I , -WA') -;7p-r? -)„1 r,ow
P
Oil _,.._.
r
tePT eomt, - L 'pit .