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1985-473 BUILDING PERMIT TOWN OF QUEENSBURY WARREN COUNTY, NEW Y©RK s ' a Cam. PERMISSION is hereby granted to Street. Road or Ave. OWNER of property located at � Sewage Alteration 0 n in the Town of Queensbury, To Construct or place a ::r at the above location in accordance to application together with plot plans and other information hereto filed and {p K approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. {p I-i 1 . OWNER'S Address is Rp # 2 Glens Valle , New 'York r 2. CONTRACTOR or BUILDER'S Name 0 N Hometown Sewer n (D 3. CONTRACTOR or BUILDER'S Address rd C1 21 Mt . Ave . Warrensburg , N . Y . 4. ARCHITECT'S Name r6- TY CHITECT'S Address Cf7 iD PE of Construction — (Please indicate by X) W l I Wood 'Frame { ) Masonry { ) Steel { ) :P' 7. PLANS and SpeaifioatiOns M 1000 gallon tank , dirt _ box and 200 ft _ leach field , { No- lication submitted . $w per plot and app � + �w• 0 S. Proposed use Sewage system for dwelling $10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Axacfust 26 79_$ 7 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queenshury before the expiration data.) Dated at the Town of Queensbury this .2 t h ,_Day of At�cr�tt sf --tig--$-e ; d' r& for the Town of Queensbury SIGNED BY / Building and Zoning Inspector TOWN OF QUEENSBURY '� ~f BUILDING & ZONING DEPARTMENT TOWN OFQU� L3r� t jN � ( S'V%TAGF DISPOSAL PERMIT APPLICATIOIa ' "y 1 . Owner ' s Name d� � s � . Address 12345s Telephone No . C/ , = e:� 2 . Property location T r -.k _ -- jau ,4 Q R 3 . Name of person or firm responsible for installing system _7. Telephone No . _ Address 4 . Number of bedrooms ( residential buildings only ) S . Daily flow cycetY- gallons/day r � 6 . Septic tank capacit - gallons 7 . Topography : flat , rolling , steep % of sloped �'�r� 7 8 . Nature of soil and depth . 90 if ground water , bedrock or impervious material is apparent at what depth does it begin? / 1r, f -to lo . Percolation test : A is required B is not required C If required what is the rate minutes/inch 11 . Water supply : municipal , well , others ---- 12 . Type of system proposed. : drywell , tile field , other ,, r20p ,rG,z_��yC7G�j' 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 Sanit 7y Sewage +ordinance . Date sLitinature of applicant On separate sheet of paper submit a dd�ia__� re�am of the proposed septic system with all dimensions , including distant rom any structure , distance from property line and domestic water supply , etc . Include all dimensions of the system itself . Form 3 - 82 . i E'E�SgURY � TOWN of: C'�U Building ©e,partm,ant 3a �' Usi Report . G l�iame rL t_1 `Z. Remarks ,rxca#a t on ooti.n Forms F otin & Pier Fo ndatlon r Ce nt Coat Wat r roofin Bac ill Fina SUxvey Fxami Sheat . n Roof F t Roofin IIIIIIiIIIP S.I Masonr a eer Roes h PY Realef Va es p1a1.I Boar sxt . Porc e Finished to r nterior Tri stairs & Rail ' n s Cedar D Ti e Cr3ncret Florar P2 F xtures Gar . Fi a roofi Door C sers Chinn@ nSt . Water eter Se c g royal. J� Found I'nsn3ation Walls Ceilin a ild ng XnsPector . REMARKS � ,� LYJ3 111ame 10 A. M. Weather Tamp. Location 3 P. M. Wathe r Tamp. one. No, Working Dwy's to Bata Contractor*' Man Today Complete Summary of pay ts s Work ` Ao�wl. f COAIFJ C � V 4. t 7 +v` 4s Srrywrintawdent