8553 BUILDING PERMIT
TOWN OF QUEENSBURY 8553
No.
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Erwin H. Johnson
OWNER of property located at Hanneford Road Street, Road or Ave. n
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. • 0
1. OWNER'SAddressis 24- Sherwood Drive• -p
Glens Falls, New York •
2. CONTRACTOR or BUILDER'S Name
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Robert Ellsworth
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name V
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. 9-1
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5. ARCHITECT'S Address lv
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) •• V
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7. PLANS and Specifications •
1000 gallon septic tank, dist. box g,
No• 180 L.F. tile field ( 6 laterals @ 30' each) Lct
per plot plan and application submitted. -
8. Proposed Use V ,I..1
Sewage system for dwelling - n
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 12 19 8 6
(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.) V -
Dated at the Town of Queensbury this -12th Day of June 19 84_
SIGNED BY ft' Gee.. V a 4J1.41 - for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUFFNSBURY
BUILDING & ZONING DEPARTMENT TOWN OF QUEENSBURY
SEWAGF DISPOSAL PERMIT APPLICATI £ VD 1 U, i=e1Dip
1. Owner ' s NamealViltijOri
56' 5i O e A.M.
Address
��! I/Z� ��8�9�1� 1�2�3�4I5I6
6L& E' s Telephone No. 92 c/o2.1
2. Property location �iX/A/ P-O�D z„0,44.1tietc
3 . Name of person or firm responsible for installing system ®,25.
k»,2`7-7--/ Telephone No.
Address
4. Number of bedrooms (residential buildings only)
5. Daily flow 3 0 2 gallons/day
6. Septic tank capacity (0,9,6 - gallons
7. Topography: rolling, steep '
% of slope
8 . Nature of soil and depth j,7A/P &e,,9(7F-J /LL) . G 06."/( 271J .4 5
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ft.
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10. Percolation test: A is required
B per_ is not required
C if required what is the rate :7 -eminutes/inch
11. Water supply: municipal, well, other jitJt'Z �,
12. Type of system proposed: drywell, tile field, other '/LZ=-
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.
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Date 5/11 / 0O y f
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.
4, exv,-a_4%7
Form 3-82
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TOWN OF•QUEENSBURY
Building Department
Inspectors Report Date 5 ///?.9'
Name -„',EityA/3c//7
Location „4-WX/4 -0A w> e�
. Permit No. 449- 6 Weather
G G�Zc) 1 7- f553 Remarks
Excavation
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 � ,/ t/'`N
Floors •
Insulation Foundation
Walls
Ceiling '
Building Inspector
REMARKS
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rr d 11/9
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