8004 BUILDING PERMIT
• TOWN OF QUEENSBURY No. 8004
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Tom Jones
OWNER of property located at 1 Poplar Lane Street, Road or Ave.
1-3
in the Town of Queensbury,To Construct or place a Sewage Alteration 0
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
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1. OWNER'S Address is 581 Glen St.
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Jay Sweet
3. CONTRACTOR or BUILDER'S Address
R. D. #1 Bay Road H
Lake George, New York
4. ARCHITECT'S Name - b
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5. ARCHITECT'S Address
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6. TYPE of Construction.—(Please indicate by X)
( I Wood Frame ( ) Masonry ( 1 Steel ( )
7. PLANS and Specifications
No. 190 LF tile field per plot plan and application
submtted.
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8. Proposed Use
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Sewage system for dwelling. CD
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$ 10. 00 PERMIT FEE PAID—THIS PERMIT EXPIRES July 28 19 85
. (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.)
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Dated at the Town of Queensbury this 28th . Day of July. 19 83
SIGNED BY S�G� �C� pp,_,, �� L a for the Town of Queensbury
B Iding and Zoning Inspector Ez
•
TOWN OF QUEENSBURY
.�. BUILDING & ZONING DEPARTMENT TOWN OF QUEENSBURY
c\' SEWAGF DISPOSAL PERMIT APPLICATION RECEIIVED
1. Owner ' s Name
/v/ j 6 S c�' .l Ld719s
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Address / o � 1 L.a itAll: e,c,-
7�8 9�10`11�12 [) 1314151
Telephone No. / - 5
2. Property location / l� \ //. r
3. Name of person or firm responsible for installing system
�tt (,a_v NS u L eCJ e � Telephone No. J3-'4 VT
Address ~ l�`� P �..:- J �f
4. Number of bedrooms (residential buildings only)
5. Daily flow gallons/day
6. Septic tank capacity gallons
7. Topography: flat, rollin ,� steep
% of slope �eL/r
8 . Nature of soil and depth Sc vu L
9. If ground water,ter, 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: m nicipr 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
Queensbu y Sani.tary Sewage Ordinance.
Date (�- �/X�j �/�//�/J' '
s4, nature 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
TOWN OF QU•EENSBU Y
Building Department
Inspectors Report Date . .� _g
Name � `re/i/ d c-""
' L ocatiOU / P ,5'1./lam
• Permit No. =fiVW/, W then
Sd e)zi Remarks
Excaiia 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.
Septic Approval
Floors
Insulation Foundation
Walls
Ceiling
Btfi li ig Inspector
REMARKS
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