8099 BUILDING PERMIT
TOWN OF QUEENSBURY No. 8099
WARREN COUNTY, NEW YORK
'
Paul LopeztsPERMISSION is hereby granted to
OWNER of property located at Indiana Ave. Street, Road or Ave. ti
O
Alteration e in the Town of Queensbury,To Construct or place a SewagecJ
at the above location in accordance to application together with plot plans and other information hereto filed and N
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is Indiana Ave.
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer Service I-+
3. CONTRACTOR or BUILDER'S Address
53 Fourth St. P.)
Glens Falls, New York
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) -
( .)Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications CD
new 1000 gallon tank and 8 'x8 ' drywell per plot plan and �'
No.
application submitted. m
8. Proposed Use FH-'
ft
Sewage system for dwelling , K
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Sept. 16 1985
(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 16th Day of Sept. 19- 83
SIGNED BY /h7 a for the Town of Queensbury
Building and Zoning Inspect •
OF QUEENSBURY
TOWN OF QUEENSBURY j (d OE fi 'p E
1]
?OWN
BUILDING & ZONING DEPARTMENT 15 �C, �I
'" 7AGF DISPOSAL PERMIT APPLICATION 'SEP w �61983 ` d
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Owner 's Name ,U7I$ �I 2 3�4 5'6
sla� a�a �, .
Address '---- 'j<_._47tifej/t.)4 ney-C_ 6t.1 44-
Telephone No.
2. Property location J '9i(1_(
3 . Name of person or firm res onsible for installing system
� � l 17eGULCr -OW(-C Telephone No. 79a-7(:)- J-->
And
4. Number of bedrooms (residential buildings only) r ' _
5. Daily flow 0-6 a gallons/day
6. Sert tank capacity 6 d 6 gallons
7. To. , -. . .x/ny: 41111, rolling, steep
% of slope
8 . Nature of soil and depth
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 Q.-i minutes/inch
11. Wat runply: municipal, well, other
12. Type (Ji system proposed: drywell, 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 st-7- t to a penalty of $250 as provided for in Section 6 .010 of the
Queensbr . iitary Sewage Ordinance-.
Date 7/X ) �' P �iC.�'�:
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.
AI. ) 0 0 0 "1- 6.44. �
Form 3-82
SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N.Y. 12801
TELEPHONE 792-7257
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