1985-112 BUILDING PERMIT
TOWN OF QUEENSBURY No. 85- 112
WARREN COUNTY, NEW YORK
Ronald Dermady �
PERMISSION is hereby granted to 0
15 Kiley Lane Street, Road or Ave.
OWNER of property located at i
Sewage Alteration
in the Town of Queensbury, To Construct or place a 0
at the above location in accordance to application together with plot plans and other information hereto filed and (p
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
t . OWNER'S Address is
15 Kiley Lane
Glens Falls , New York
2. CONTRACTOR or BUI LDER'S Name F
Condon ' s Septic and Drain Service
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3_ CONTRACTOR or BUILDER'S Addressi rant Ave � iA
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Glens Falls f New York
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d. ARCHITECTS Name
S_ ARCHITECT'S Address
6. TYPE of Construction — lPIease indicate by X)
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I ) Wood Frame ( I Masonry 1 1 Steel I } p
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7. PLANS and Specifications :y
repair and restone existing drywall # stone
No• per application and plot plan su�nittedo rt
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8. Proposed Use
Sewage System for dwelling °
$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Agri 1 12 19-5-�-
(if a Ionger period is required an application for an extension must be made to the Building and Zoning inspector of the
town of 011eensbury before the expiration date.)
Dated at the Town of Queensbury thus- trry��� ,� ,t j /'� Day of r4 Z)y i 1 -1g—� -�--P.P.
S1 G N E D BY "` for the Town of Queensbury
Building and Zomng knspecto
TOWN OF QUFFNSSURY .ram f
BUILDING & ZONING DEPA.R.TMENT �� � �F G?U�EIVSBUF3Y
SFWAGF DISPOSAL PERMIT APPLICATA
1 . Owner ' s Name 0 A � ,� I� ] /loci�`�'� ,^ � 7
Address d� ►'U .' MIS Is a JzJ
Telephone No l
2 . Property 1pcation
3 _ Name of perso^n,, or firm responsible for Installing Systern� d`,
`/ v'Jrs.A iQ S Le, / -- Telephone No .
Address j �J r r i�l
4 . Number of bedrooms ( residential - buildings only) '
5 . Daily flow gallons/day
6 . Septic tank capacity Z400C) J gallons
7 . Topography : flat , rolling , steep
% of slope
8 . Nature Of soil and depth-4�J,/j�G���
9 . If ground water , bedrock or impervious material is apparent at what
depth does it begin? rr C1`7'L ft •
10 . Percolation test : A is required
g is not required
C if required what is the rate minutes/inch
ll . Water supply : unicipal w her
R f, pppl i)k
12 . Type of system proposed : dryc+fell , 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 Sanitary Sewage Ordinance .
Date A } I �cant
s gnatu e o apP
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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