7983 BUILDING PERMIT
TOWN OF QUEENSBURY No. 7983
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to William Moore
OWNER of property located at 56 Revere Road Street, Road or Ave.
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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
R. D. #3 - 56 Revere Road
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
William Threw
3. CONTRACTOR or BUILDER'S Address
R. D. #3 Luzerne Road
Glens Falls, New York
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address fi
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6. TYPE of Construction—(Please indicate by X) Sal
( ) Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications
new dist. box, 2 drywell seepage pits @ 6 'x8 '/2 '
No. stone per application submitted.
8. Proposed Use -
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Sewage system for dwelling
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 25 1985
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the (D
town of Queensbury before the expiration date.) -
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Dated at the Town of Queensbury this 25th Day of July 1983 O
SIGNED BY _ S_ Zda-k, , . of for the Town of Queensbury
Buil ing and Zoning Inspecto
TOWN OF ;QU ENS UR vG 4---
6' BUILDING & ZONING DEPARTMENT EGME 0
SEWAGF DISPOSAL PERMIT APPLICATION
./i tit- k� - 1983
1. Owner 's Name 4,_ . . Ali , A"------, E. 4/00R Q. gin.
Address -- r(�, ,
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7'K ll ig f`f/here Telephone No.
2. Property location '
3 . Name of person or firm responsible for installing system
/4.r 7.htQ h% Telephone No. ?? 3 7' '/
/7D '� 3 6�X 2 '�. ,6Z e;y L _ � r
Address S�� _ ��
4. Number of bedrooms (residential".buildings only) 7,
5. Daily flow ' gallons/day '
6. Septic tank capacity .(c ckey gallons
7 . . Topography: Eflt, rolling, steep
% .of slope
8 . Nature of soil and depth 57,,N(../ ,
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? -% ft.
10. Percolation test: A ' is required
B. f, is not required
C If required what is the' rate minutes/inch
11. Water supply: municipal, well, other
12. Type of 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 subject to a penalty of $250 as provided for in Section 6 . 010 'of the
Queensbury Sanitary Sewage Ordinance.
Date 71 7s -y ' z � �� / �-�. ;,e,s•
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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 0 ::O e 2;W --