8460 BUILDING PERMIT
TOWN OF QUEENSBURY No.8460
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Stan Czaban
OWNER of property located at Seelye Road Street, Road or Ave.
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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
' P. O. Box 122
Cleverdale, New York
2. CONTRACTOR or BUILDER'S Name
Condon"s Septic Service
3. CONTRACTOR or BUILDER'S Address -
17 Grant Ave.
Glens Falls, New York ~'
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4. ARCHITECT'S Name 'h
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
1000 gallon tank, dist. box and 150 ft. leach field
No. per plot plan and application submitted.
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8. Proposed Use >1
Sewage system for dwelling m
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 4 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.)
Dated at the Town of Queensbury this 4th Day of May 19 84
SIGNED BY ti)91 0, � -�� for the Town of Queensbury
Building and Zoning Inspector
TOWN OF OUEENSBUR`l
- / J TOWN OF QUEFNSBURY .
BUILDING & ZONING DEPARTMENT RE
vilivED
SEWAGE DISPOSAL PERMIT APPLICATION
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1. Owner ' s Name S��ry C .-4/2,4✓ ^� ry �$����.���� J���3}?15.P.m,
Address S 'eLy QcI C�. /eoe/�d 7r4/F FeAV-SRUXI-� �.
Telephone No. 6', 3
2. Property location
__.3.. Name of person or . firm responsible for installing system Q�l/0C 3
vet°cc SSA Telephone No. 7l't,S' S`` 2-
Address /a? 0#2_14/1/4 Xe/E arFivs a< s )--eferi
4. Number of _bedrooms (residential buildings only)
5. Daily flow gallons/day _
6. Septic tank capacity /1.Z'0 f0.01/5 gallons
7. Topography: flat, rolling, steep
% of slope . ..-fd
8 . Nature of soil and depth acly IF eppef f/il
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? -0.-/ 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/-Eichl F(EJd
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 5-'�`—�� C3_
signatur 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.
pitzieet_44/ (I ( crika :tgr X
Form 3-82 ` fieetakic,efe/
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TOWN OF QUEENSBURY
Building Department
Inspectors Report Date aJr/ 9'4
Name (- z
Location 1r1J
Permit No. 19 Weather
Remarks
• Excapation
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
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Floors '
Insulation Foundation
Walls •
Ceiling
-41: L1?-47
• Building Inspector
REMARKS
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