8412 BUILDING - PERMIT
TOWN OF QUEENSBURY No. 8412
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Claire Cifone
OWNER of property located at 4 Greenway North Street, Road or Ave. 1-1
in the Town of Queensbury,To Construct or place a Sewage Alteration 1-1
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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.
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1. OWNER'S Address is 4 Greenway North
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Carl Dingman
Reliable Sewer Service
3. CONTRACTOR or BUILDER'S Address
RD #4 Luzerne Road
Glens Falls, New York •
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4. ARCHITECT'S Name (D
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5. ARCHITECT'S Address p
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
1000 gallon tank, dist. box and 2 6 'x8 '
No. seepage pits with #3 stone per plot plan
and application submitted.
8. Proposed Use
Sewage System for Dwelling m
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRESApril 20 19 86
(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.) f�
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Dated at the Town of Queensbury this 2 0th Day of April 19 84 ~'
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SIGNED BY //'?Gffi 47_N �) for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEENSBURY
BUILDING & ZONING DEPART
SEWAGE DISPOSAL PERMIT APPLI'. ' ION,
1. Owner' s Name 5 a
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Address
Telephone No.7 F -?/ 7
2. Property location
3 . Name of person or firm responsible for installing system
• ?r� Telephone No. 7
Address Ar� - � � ` x r ^��
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4. Number of bedrooms (residential buildings only)
5._. Daily flow gallons/day
6. Septic tank capacity j Q CQ-c? gallons
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7. Topography: flat, rolling, steep
% of slope •
8 Nature of soil and depth 0„4
9. If ground water, bedrock or im ervious material is apparent at what
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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 ay✓ ig7J
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12.. Type of system proposed: ( Ywe_ tile field, other ter., ;p ,
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. . l
Date 1/// / 1/2-1,
s a e of 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. .
Form 3-82 .
TOWN OF•CQUEENSBURY
Building Department
Inspectors Report Date -7i'�8,/R4
Name C/, O/Ve-
L,ocatioa/ /&4, t )4' �V1 17
. Permit No. $ / 'Z Weather
CA jQL. `Di A) 71?,4-IJ Remarks
Excat'ta t on
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.
Septic Approval
Floors
• Insulation Foundation
Walls
Ceiling
Building Inspector
REMARKS
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