8772 BUILDING PERMIT
TOWN. OF QUEENSBURY
No. 2772
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Curtis Mayott
OWNER of property located at 134 Dixon Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration n
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 134 Dixon Road
Glens Falls, New York
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2. CONTRACTOR or BUILDER'S Name
Same
3. CONTRACTOR or BUILDER'S Address
Same I--�
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4. ARCHITECT'S Name CJ
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5. ARCHITECT'S Address 0
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
4 'x6' drywell - repair to existing system
No. per plot plan and application submitted.
8. Proposed Use
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Sewage system for dwelling y
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Sept. 20 19 86 rt
• (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 0
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 20th Day of September 19 84
SIGNED BY /na- - • & for the Town of Queensbury
Building and Zoning Inspecto�
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TOWN OF .QUERNSBURY Tu N OF QUEENSBURY
BUILDING & ZONING DEPARTMENT REG E E
SEWAGF DISPOSAL PERMIT APPLICATION SEP Z 9171,1
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1. 'Owner ' s Name C v ,� ; /5 fir/ . �/ Y� 7 �� P.M.
,5,.M: /0 ��, f
� 34 � G -
Address -I 17 �,rd, � ,�� 191�. � �� � �•
Telephone No. 7"25
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2. Property location f ��
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3 . . Name of person or firm responsible for installing system
Telephone No.
Address
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4. Number of bedrooms (residential buildings only) 3 s
5. ' Daily flow d )) gallons/day
6. Septic tank capacity /) - gallons
7. Topography: flat, rolling, steep
% of slope - '/A-
8. Nature of soil and depth &d a
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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: nu�nicipa1, well, other
12. Type of system proposed: rywel , 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.
Date 7 /V x V
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.
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Form 3-82 is w (0/_v() --LL- f f2.. 6_re_ e K w�T
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• TOWN OF QUEENSBURY
Building Department
Inspectors Report. Date 9 / -
Name a U c 1'}JS ,��i �i�%
Location I R L-/ r7, x
Permit No. ,: -'�;i J7)2. Weather
Remarks
Ekcatia ti 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. j
Septic Approval
Flodts
FOUndation
Insulation
Walls
Ceiling
• Building Inspector
REMARKS
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