1985-346 BUILDING PERMIT
TOWN OF QUEENSBURY No. _ a=3Ax
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Arlene Robin Scan
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OWNER of property located at J Birch Road . Glen Lake Street, Road or Ave.
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in the Town of Queensbury. 'To Construct or place a _ Sewage Alterati can
at the above location in accordance to application together with plot plans and other information hereto filed and
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. (D
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1. owNER'S Address is Birch Road r Glen Lake �
Lake Georger New York V
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FCONACTOR or BUI LDER'S Name
D . Granger anal. Sons
ACTOR or BUILDER'S Address
Homer Ave .
Glens Fallsr New York
4. ARCHITECT'S Name
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'S Address .�
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struction — (Please indicate by xl j
ood Frame I I Masonry 1 ) Steel ( 1
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pecifications
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1000 gallon tank . pump station and 8 ' xl4 ' drywellper plot plan and application submitted .
ewage system for dwelling
10 . 00 PERMIT FEE PAID] — THIS PERMIT EXPIRES Tub Y 79_ $ 7
(If a longer period is required an application for an extension must be made to t h a Building arld Zoning inspector of the N
town of 4ueonsburV before the expiration date.l
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Dated at the Town of Queensbury this 9tYs Day of ,Tiny 19 85
for the Town of Queensbury ¢
SIGNED BY C
Building and Zonirg Inspector 91 �
C
TowN +CF' QUEENSBUHY
TOWN OF QUFFNSBURY [R FM (�A��3 F= 0 1Y
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q Y BUILDING & ZONING DEPARTMENT
3 1 SFWAGF DISPOSAL PERMIT APPLICATION JULIII
l4M: to
10 owner ' s Name
Address� l ~
Telephone No .
2 , Property location_ 1,_ L a.a, n IJ4r Lg.�
3 . Name of person or firm responsible for installing system+-., ny
.�..." . 46' •r.�+'' Telephone No .
Add d+.r ee s
4 . Number of bedrooms ( residential buildings only ) ^0
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5 . Daily flow Gallons/day
6 . Septic tank capacity. % a gallons
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7 . Topograp flat , olling , steep
slope _
8 . Nature of soil and depth ' ..rr le, jo �4A
9 . If ground water , bedrock or impervious material is apparent at what
depth does it begin? ft .
10 . Percolation test : A is required
B is not required
C If required what is the rated *" -S , minutes/inch
11 . Water supply : municipal well other
12 . Type of system proposed : =ryweilip
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 varie from the approved application
Will be subject to a penalty of $ 250 as pr ided for le Section 6 . 010 of the
Queensbury ;;Q
Sewage Ordinance .
Date ' f+ignatatu o ap scant
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 �tl � »�
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TOWN OF QUEENSBURY
Building Department
inspectors Report Date
Naaa
Location
P , No. weat'4mr
Remarks
Exca0aLion
Footin Forms
_ Footing & Piers
Faunc3aLion
,Cement Coat
Water roofin
_ BacJcfill
_ Firxa.I su.rv�e� "
Framin _
Sheathing
Roof Pei
Roof-in
siding
Masonry Veneer
Rote h PJ
Relief valves
Wall Board
Ext . Porches
Finished Floor -
Inter i
ior Trm
Stairs & Railin s -
Cellar Dr . Tile
Concrete Floors
p1ha , Fixtures
Gar , Fire roofin _.__. .
Door C111111�1losers
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mne
Water Meter Inst .
Se tic A rovai _
Floors —..
Foun�On
nsulation Walls
I
Ce%lin
Susldxng Inspector
REMARKS
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