8577 BUILDING ' PERMIT •
TOWN OF QUEENSBURY Na 8 577
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Curtis and Cynthia Haak " 1-1
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OWNER of property located at Dawn Road Street, Road or Ave.
.. to
in the Town of Queensbury,To Construct or place a Sewage System
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 15 Elm St. -
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Hudson Falls, New York
2. CONTRACTOR or BUILDER'S Name Frank Shaw c'
• 7ti'
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
0
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5. ARCHITECT'S Address •
6. TYPE of Construction—(Please indicate by X) -
•
( )Wood Frame ( ) Masonry ( )Steel ( ) •
7. PLANS and Specifications
1000 gallon septic . tank, dist. box and 200 :• �n
No. feet tile field per plot plan and application
submitted.
8. Proposed Use (D
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Sewage System for Mobile Home
En
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5
$ 10. 00 " PERMIT FEE PAID —THIS PERMIT EXPIRES June. 18 • 198 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.) .
Dated at the Town of Queensbury this 18th Day of June 198 4
SIGNED BY 'Mad d N for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEFNSBURY
BUILDING & ZONING DEPARTMENT TOWN OF QUEENSBURY
SEWAGF DISPOSAL PERMIT APPLICATIONR EGEfivE 0
1. Owner ' s NameL/, A, reyirl'A, .44A JUN 1.81984
. �� 1�. r
Address. /5_ ,Q AM P.M.
• Telephone No. .9 � 7 /L,&
2. Property location 4/4/7 h',49 4./-CCU ahe
3 . Name nnot person or firm responsible� for/ installing system
F Ct i /< , c/ (//� 6) ( -ar+7'»�a c?ToP Telephone No. 7- 9..3--,9 //v-
• Address
4. Number of bedrooms (residential buildings only) 3
5. Daily flow 1/5 0 gallons/day
6. Septic tank capacity // '-CD gallons
7 . Topography: rolling, steep
% of slope F-/ `�
8 . Nature of soil and depth -0lQ y
9. If ground water, bedrock or impervious material is apparent at what
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: unicipa , well, other
12. Type of system osed: drywell, the field, they
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 yel /2 74 ,�2] 4/, 1.4
1��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.
Form 3-82
•
TOWN OF'QUEENSBURY
Building Department
Inspectors Report Date 6-//e/E Y
Name f 1 < /:/74/(-
Location (' nift/
. Permit No. 7C ) Weather
•
Remarks
Excavation
- Footing Forms
Footing & Piers 1
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 L/ C3 Gam_
F1ob.ts '
Insulation Foundation '
Walls
'Ceiling '
• Building Inspector
REMARKS •
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