8397 BUILDING PERMIT
TOWN OF QUEENSBURY No. 8397
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Curtis Walls
OWNER of property located at 23 Cottage Hill Road n
p p ty Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration N
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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.
1. OWNER'S Address is ~
23 Cottage Hill Road �
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Daniel Drellos
Sanitary Sewer Service
3. CONTRACTOR or BUILDER'S Address
53 Fourth St.
Glens Falls, . New York
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4. ARCHITECT'S Name ()
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) cal
7. PLANS and Specifications
No 1000 gallon septic tank, 8 'x8 ' dry well per plot
• plan and application submitted.
8. Proposed Use
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Sewage system for dwelling
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 19 19 86
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 19 th Day of April 19 4 e
SIGNED BY ad Lf 6.)g for the Town of Queensbury
wilding and Zoning Inspector
TOWN OF QUEENSBURY
.f- ' BUILDING & ZONING DEPARTMENT
SEWAGF DISPOSAL PERMIT APPLICATIONDwN OF' QUEENSBURY
1. Owner ' s Name e
L/ lL7 / S: a✓i4-/ir 2ECEfiVE
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Address .43 Co fl/�/ ��� #� R Q) 19 4 A.M "i /d od
TelephoneJ ,. P.M. �'
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2. Property location
3 . N el of person or 'rm responsible for installing system
i,i� (ixklv-, ewo ; Telephone No. —72-Li 2
Address •
4. Number of bedrooms (residential buildings only)
5. Daily flow g O2) gallons/day
6. Septic tank capacity gallons
7 . Topography: fl , rolling, steep
of slope
8 . Nature of soil and depth &till' l
9. If water, bedrock ground
c or impervious material is apparent at what
depth does it begin? ft.
10. Percolation test: A K. is required
B is not required
' C If required what is the rate minutes/inch
11. Water supply: •P well, other
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 application
will be subject to a penalty of $250 as provided for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance.
Date4-16 - ,Z A �`� ,r�
signure off'. (cant
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.
/.....-- / a 420 qe. c.P/nc 4(
Form 3-82 /' -
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SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N.Y. 12801
TELEPHONE 792-7257
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