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1985-466 BUILDING PERMIT TOWN OF QUEENSBURY No. 135_ 466 � N�s � WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Edward Hutchinson � phi OWNER of property located at 2 C Rroadacres Road Street, Road or Ave. in the Town of Queensbury, To Construct or place a Sewage Alteratiori at the above location in accordance to application together with plot plans and other information hereto filed and n approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. M• uo 1 . 'OWNE R'S Address is 20 Broad.acre s Road o Glens Falls , New York 2_ CONTRACTOR or BU1 LIRE WS Name lV Sanitary Sewer Service ' t� rt 3. CONTRACTOR or BUILDER'S Address a 53 Fourth St . g, Glens Falls , New York n ro 4. ARCHITECT'S Name W 0 lv 5. ARCHITECT'S Address B_ TYPE of Construction --- (Please indicate by XI ( ) Wood Frame ( ) Masonry ( ) Steal ( y rn [D 7. PLANS and Specifications 1000 gallon septic tank , dirt . box and 200 ft . leach Pi LQ No. field per plot and application sulsnitted . ro B. Proposed Use (- Sewage system for dwelling r*o sv rt M- p $ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES Aug . 23 19 3 � (If a longer period is required an application far an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) Dated at the Town of Queensbury this 23rd , Daay of August 19 85 SIGNED BY �^ for the Town of Queensbury Building and Zoning Inspector TOWN OF QUEENSSURY TOWN OF QUEENSBURY Val 16 �BUILDING & ZONING DEPARTMENT SEWAGE DISPOSAL PERMIT APPLICATION l . owner ' s Name E __�___� IV` t T C ' �.�t re ,✓ S1(}Z12i ? 2 } 4 i 5 fi Address a Ci �j (J-.C1+p Je Telephone No . 2 . Property location 3 . Name of person or firm responsible for installing system l r-elrj Cj elephone No . 7 Address 4 . Number of bedrooms ( residential buildings only) 5 . Daily flowE`j gallons/day 6 . Septic tank capacity � �1 G.' � gallons 7 . Topography : flat rolling , steep % of slope 8 . Nature of soil and depth, 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 rate minutes/ inch 11 . Water supply : unicipalwell , other 12 . Type of system proposed : drywell file 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 pro d for in Section 6 . 010 of the Queensbury San ' {teary Sewage ordinance . Date�� C J GT si to a of applic t 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 . C fir— Form 3 - 82 TOWN 'OF QUEENSBURY Building Department 1wspeckwa Report Naarre Permit No. W�athex Remarks I tionn Fortesn & Piersationt Coat roofini.l l SUrvenhinFeltnSng Masonry veneer Rou h pl Relief valves Wall Board - Ext . Porches Finished Floor Interior Trim Stairs & Rallin s Cellar Dr . Tile Concrete Floors pl Fixtures Gar . Fireproofing Door Closers Chitrrne Water Meter X nst . Septic A rova-7 Floors Foundation Insulation Walls Ceilin Le(, � 1d ng� _ REMARKS SANITARY' SEWER SERVICE S N .Y . PHONE 792 - 7257 LU2ERNE R©. GLENS FALL i Ak I I i 1 ! r7 I i x 4.3