1985-258 BUILDING PERMIT
` TOWN OF QUEENSBURY No. 85_ 258C?
� , G-�`-"" ! � — G�[J WARREN CUNTY, NEW Y()R K
PERMISSION is hereby granted to
OWNER of property located at _ Jl i sr i inn treat Street. Road or Ave.
in the Town of Oueensbury, To Construct or place a
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. �
F3OONTRACTOR
ER" Address is Box t; Division St .
Glans Falls , New York M
TRACTOR or BUl LDER'S Name Ii
(b
Sanitary Sewer Service �c
or BUYLDER'S Address
P . O . BOX 224
Glens Falls , New 'York Iv
4
4. ARCHITECT'S Name µ''
to
rm
0
c
cn
S_ ARCHITECT'S Address S F
B. TYPE of Construction — (Please indicate by X)
I I Wood Frame I ) Masonry t ) Steel I ?
7. PLANS and Specifications
100D gallon septic tank , disc - bOxt drywells
su�extitted .
No. � , n # stone per plot plan and applicationm
y
B. Proposed Use M
Sewage system for dwelling �>
s*
June 4 1� 87 w
$ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES �
r-
(lf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the C5
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 4th Day of 'Tune 19 S 5
SIGNED BYCLCCt' for the Town of Queensbury
-� Building and Zoning Inspector
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT TOWN OF QL3r=ENSB'J ? '`
SEWAGE DISPOSAL PERMIT APPLICA'TION�} IE 0
LF
10 Owner • s Name on o �111�11�tt i
Address f vI
.__.
.A'
Telephone.
2 . Property location
3 . Name of person or firm responsible for installing system
Qu � ^ —..'Telephone No .
Address CD _ e l� '
4 . Number of bedrooms ( residents l buildings only )
5 . Daily flow 4 �0 gallons/day
6 . Septic tank capacity 10 40- CJ gallons
7 . Topography : flat rolling , steep
% of slope /
8 . Nature of soil and depth /_ r 1 4 �" 0
9 . If ground water , bedrock or impervious material is apparent at what
depth does it begin? f t 0
10 . Percolation test : A � is required
B is not required
C If required what is the rate V- ,5r minutes/ inch
11 . Water supply : municipa' well , other
12 , Type of system proposed : drywe 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 f e
OF sig ature of a cant
On separate sheet of paper submit a dia ram 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 * �/ / C _ tS' �. L o
l le �.3.A
Form 3 - 82
mrow" QF QUEENSOUR-Y
B,uildio� DePsrt�nent
S
Nasne '�"
w e- ►dame[._--
p� No.•. Remarks
-- Excat*ation
- Faota.n Forms
- Faotin & Fiers
- Ceme t coat
- Water roofin
gackfill
- Final Stirve
- Framin
Sheat Felt
Roof
_ Roof in
— Sidin9 Veneer
Masonr
Rau h 'l
- Relief Valves
ygall Board
— Ext - Porches
Finished Floor
— interior Trim s
Stairs & Rai lin
cellar Pro Tile
— Concrete Floors
Fl Fixtures
Fire ravfxn
Gar -
Door closers
Chirane Inst -
Wa Metex
ter
A raval �--"
5 tic e FlOO- s
Walls
insulation ceilixi
lik --�
I nsr
ux
RE2yp},gKS
-� �
SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N . Y. 12801
TELEPHONE 7921111,7257
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