1985-536 BUILDING PERMIT
TOWN OF QUEENSBURY No. Rri_ S16
�y WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to G
an
OWNER of property located at 1 Ei5qnnhnwe4r Av p and T A UM T yr i t___ Street, Road or Ave. L~
in the Town of Queensbu ry, To Construct or place a wa g P A l t ar a t t—h.
at the above location in accordance to application together with plot plans and other information hereto filed and Pi
approved and in compliance with the Town of Oueensbury Building and Zoning Ordinance. C7
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1 . OWNER'S Address is Eisenhower Ave . and Dawn Drive
Glens Falls , New York
2. CONTRACTOR or BUI LDER 3 Name (D
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same �
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3. CONTRACTOR or BUILDER'S Address (D
same
4. ARCHITECT'S Name
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5. ARCHITECT'S Address O
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6. TYPE of Construction — (Please indicate by Xi C
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( 1 Wood Frame ( 1 Masonry ( I Steel I ? py
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7. PLANS and Specifications
1000 gallon septic tank , dirto box and 2 6tx8 ' drywel s 0
No, with 24 " stone per plot and application submitted .
S. Proposed Use
Sewage system for dwelling C
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$ 100 00 PERMIT FEE PAID — THIS PERMIT EXPIRES septo 20 19 87
(If a longer period is requ fired an application for an extension must be made to the Building and Zoning inspector of the ly
town of Queensbury before the axpiration date.)
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Dated at the Town of Queensbury this 2 0th Day of _ S e!pt . 1985
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SIGNED BY for the Town of Queensbury ff
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Building and Zoning Inspector r'1'
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TOWN OF OUFFNSBURY Towr*4 of oUEENsEtull
BUILDING i ZONING DEPARTMENT [REG {EDVISLFwAGF 1DISPOSAL PERMIT APPLICATION L ' f1V; i
__- L w ' 7 zo t t' 1 ? 1985
1 . Owner ' s Name ,
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013
A1rr11\//d d re s s
J� I ,Telephone No
2a property location -1ren\-�)()k,+1P1' 11 it LR1 � ' 1C It
3 . Name of person or firm responsible for installing system
A (3 �pC." --- Telephone Noe ? CJ3 - ozC?' C>
Address
4 , Number of bedrooms ( residential buildings only )
5 . Daily flow gallons/day .
6 . Septic tank capacity d Q 0 gallons
7 . Topography : flat rolling , steep
% of slope
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8 . Nature of soil and depth .A1A.1 f ` i-
9 . if ground water , bedrock or impervious material is ,apparent at- what
depth does it' begin? ft .
10 . Percolation test : A is required
is not required
C� If required what is the rate minutes/inch
11 . Water supply : municipal , well. , otherw � ow)
12 . Type of system proposed e. dryw- e1 the field , other r � '
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
Qu+eensbury Sanitary Sewage Ordinance .
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Date 1 � 1`� � rJ ~ V
signature or applicant
On separate sheet of paper submit a d�iagr�amm of the proposed septic system
with all dimensions , including distance from any structures distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself . _
LL 1000 .4--L Slog
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Form 3 - 8 2 1 l s[G S 0 {
'fC'QWN OF C EENSSURY
wwol&aw Department
Nsaerr .—
LAbca+ ion w, .b
Remarks
Ex'catra ti.on
Footin Forms
Footina & Piers
Foundation
Cement coat
Water roofin
Backfill
Final Surve
Framin
sheathin
.Roof Fel t
Raofin
Siding
Mason r Veneer
Rau h Pl
Relief Valves
Wall Board
gxt . Porches
Finished Floor _
Interior Trim
Stairs & Railin s
Cellar Dr . Tile
Concrete Floors
PI Fixtures
Gar . Fire roofin
Doo closers
Chimne
water Meter Inst .
Se tic A roval -
Floors
FDttridat ti on '
Insulation walls --- ~--
Ceilin
Builang Inspector
REMARKS
TOWN OF QFUEENSBURY
Building Department
Date—
Name
Perno*I Nov 1 _. Weather
Remarks
ExcatiYa is on
Footing Forms
Footing & Piers
Foundation
Cement Coat
waterproofing
Backfsll
Final Survey
Framing
sheathing
Roof Felt
Roofin
Siding
masonry Veneer
Rough PlbgI
Relief valves
wallo Board
Ext . Porches
Finished Floor
Interior Trim
StairS & Railings
Cellar ,Dr . Tile
Concrete Floors
PI Fixtures
Gar , Fireproofing
Dakar Closers
Chimne
Water Deter Inst .
Se tic Approval
Floors
insulation Foundation -�--
Wa l l s
ceiling
Building Inspector
REMARKS
40
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