7549 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 7549
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Donald Higley
OWNER of property located at Jay Road—Glen Lake Street,Road or Ave.
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. ,
1. OWNER'S Address is
R. D. #1 Box 323A w
Lake George, New York
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2. CONTRACTOR or BUILDER'S Name
Dale Granger
3. CONTRACTOR or BUILDER'S Address
107 Bay Road
Glens Falls, New York
4. ARCHITECT'S Name 0
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5. ARCHITECT'S Address
W
x
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
2 — 5'x8 ' drywells per plot plan and application
No. submitted.
8. Proposed Use
N
W
Sewage Cu
System for dwelling
Feb. t
$ 10. 00 eb. 1 83
PERMIT FEE PAID —THIS PERMIT EXPIRES 19 II
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r}
town of Queensbury before the expiration date.) F�
0
Dated at the Town of Queensbury this 22nd Day of Sept. 1982
SIGNED BY •w for the Town of Queensbury
ilding and Zoning Inspe or
TOWN OF QUEFNSBURY r�'-3 - 1 - '3
%
BUILDING & ZONING DEPARTMENT "
Y ,
SEWAGE DISPOSAL PERMIT APPLICATION TOWN OF CpUEENERURY
/
1. Owner ' s Name �f� }�� / 1,Ey REVEllVE ]
Addre 61. / / •h c x -Z3 A F 2 1 ` 82 -
ccc,R (ft. /Y, / Telephone Nq�$�9�';"1 4: ` 16
2. Property location -
3 . Name of person or firm responsible for installing system ? -�
vc � � C7,( ,,5 i Telephone No.
Address /G% 7 Y4"v /V y
4. Number of bedrooms (residential buildings only)
•
5. Daily flow gallons/day
•
6. Septic tank capacity / ( [:: gallons
7 . Topography: flat, rolling, steep
% of slope
8 . Nature of soil and depth 54/1/ ) Y--°4-7I.fy
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? if' ft.
10. Percolation test: A is required
B is not required
C If required what is the rate ["- 5- minutes/inch
11 . Water supply: municipal, well, other J,/(.9` ` c -
12. Type of system proposed: drywell, tile field, other f 7 L. ' -`
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 E • �._
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.
fL,t) s IX y (A) /Lc
Form 3-82