8878 •
BUILDING PERMIT
TOWN OF. QUEENSBURY No. 8878
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to John Plude �
OWNER of-property located at 86 Boulevard Street, Road or Ave. 'b
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 86 Boulevard
Glens Falls, New York
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2. CONTRACTOR or BUILDER'S Name Gd
Sanitary Sewer Service
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3. CONTRACTOR or BUILDER'S Address Iv
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53 Fourth Street
Glens Falls, New York
4. ARCHITECT'S Name .
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame . ( ) Masonry ( )Steel ( ) -
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7. PLANS and Specifications W
1000 gallon septic tank, dist. box and 250 ft. m
No. leach field per plot plan and application;
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8. Proposed Use -
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Sewage system for dwelling N
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Nov. 15 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 15th Day of November 19 84 -
SIGNED BY . 711 . //.,P for the Town of Queensbury
Building and Zoning Inspector(, -
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT .
SEWAGE DISPOSAL PERMIT APPLICATION
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1. Owner' s Name �? 0 (1\,Jv PC V Gt ; /d / � �f'c�
TOWN OF QLJ1 �a�l� IL
Address, I b e U �
E. 11 E
Telephonemy
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2. Property location A RM.
►71g19010111)4)e) 1`31 46
3 . Name of person or firm responsible for installing syg eme
. aDou Owl J? U`'v, re/ewe Telephone No. 79c). ). 612
Address
4. Number of bedrooms (residential buildings only)
- - 5. Daily flow (a t7 _:- gallUn"s da —
6.. Septic tank capacity 6 6 gallons
7. Topography: ! rolling, steep
% of slope
8. Nature of soil and depth SA-1(/
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ft.
10. Percolation test: A ' }C is required
B is not required
C If required what is the rate O 'S minutes/inch
11. Water supply: ELL1f21122) well, other
12. Type of system proposed: drywell, ile 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 J., ./ P 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.
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Form 3-82
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TOWN OF•QUEENSBU RY
Building Department
Inspectors Report Date .moo
• Name 1-1-Ar y u o e_.
Location 4, t 1 (.%L'. r�
. Permit No. ps4fli, Weather
1 0 Remarks
Excavation
Footing Forms
• Footing & Piers
Foundation
- Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
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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.
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Septic Approval (
Floors '
•Insulation Foundation
Walls
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Ceilin
wilding Inspector
REMARKS
EP-
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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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