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1985-097 BUILDING PERMIT TOWN OF QUEENSBURY No. 85- 97 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Phyllis Bucklin { { 8`� (3a OWNER of property located at Hay R aci below Route 14 9 Street, Road or Ave. ny in the Town of Queensbury, To Construct or place a Sewage Alteration F - i 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. N 17tl G 1 . OWNER'S Address is (') 48 Sherman Ave . W Glens Falls , New 'York ~ r- 2. CONTRACTOR or BUILDER'S Name D . Granger and Sons 3. CONTRACTOR or BUILDER'S Address 19 Horner Ave _ ro Glens Falls , New York m 4. ARCHITECT'S Name In Fj' 04 {p I;} 5. ARCHITECT'S Address 0 6. TYPE of Construction — (Please indicate by X) ( ) Wood Frame ( ) Masonry I ) Steel { I 7. PLANS and Specifications No. 10 +00 gallon septic tank , dist4 box and 190 LF the field per plot plan and application . rIs E B. Proposed Use Serage system for dwelling r-� fo $ 10000 PERMIT FEE PAID — THIS PERMIT EXPIRES April 5 19 87 W (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the I ' town of Queensbury before the expiration date-) O tj Dated at the Town of Queensbury this 5thh Day of Apr l l 19 8 5 SIGNED BY g,,,Icling and Zoning Inspector for the Town of Queensbury — TOWN OF OUFENSBURY TOWN OF QUEENSBURY BUILDING & ZONING DEPARTMENT �y ff� 19I t5 SFS%IAGF DISPOSAL PERMIT APPLICATI AMR 41 1 , Owner ' s Nameg deg sk 718� 91 lI I� .234 !+5 6 Address . . � . . ►' . Cl� � �--'�► Telephone No . .Z -� 4 2 . Property location 3 . Name of person or /firm responsible for installing system Telephone No . 63 17 Address 4 . Number of bedrooms ( residential buildings only ) . ,, 5 . Daily flow 4' W%Co gallons/day 6 . Septic tank capacity gallons 7 _ Topography : flat olling , steep % of slope S . Nature of soil and depth_ „ e�> 9 . If ground water , bedrock or impervious material is apparent at what depth does it begin? A$ hjse 6 . ft . 10 . Percolation test : A eD 4h07 is required B is not required C If required what is the rate © #- !: minutes/inch 11 . Water supply : municipal , well , Cher 12 . Type of system proposed : drywell , ile field , ther 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 frcgn the approved application will be subject to a penalty of $ 250 as provi for in S tion 6 . 010 of the Queensbury Sanitary Sewage Ordinance _ Date ^�f �, r t ign ture app t an 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 . of ewe9 Form 3 �8 2 �, {.• a ,C�.„r P-a�:�''i TOWN OF QUEENSBURY Buildina DeP&Ttmeut Y � DaheLAWAr Hama SOn W eatlxer Persamt R ...IIIIN III N s SxcatYation FoI Forms Footin & Piers Foundation Cement Coat Waterproofing Backfill Final Serve Framin Sheathin Roof Felt Roofin Siding Masons Veneer Rou h Pl Relief Valves gall Board Ext . Porches Finished Floor Interior Trim Stairs & pall in s Cellar Dr . Tile Concrete Floors Pl , Fixtures Gar . Fire roofin Door Closers Ctiinwe ,dater Meter Septic A roval Floors _� �- --- -- Irotln. Insulation iyall,s����s Ceiling Building Inspector REMARKS �f C , G ram^ C'rr S a f O d OabOL