1985-503 BUILDING PERMIT
TOWN OF QUEENSBURY No. s 5- 503
WARREN COUNTY, NEW YOR K
— Betty c . Monahan
PERMISSION is hereby granted to rr
���. Sunn side ROad Street, Road or Ave.
OWNER of property located at to
Sewage Alteration (D
To Construct or place a
in the Town of Queensbury0
at the above location in accordance to application together with plot plans and other information hereto filed an
h the Town of Queensbury Building and Zoning Ordinance.
approved and in compliance wit
1 . OWNER'S Address is RD # 1
Glens Falls , N . Y . 0
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2. CONTRACToR or BUILDER'S Name
Rick Chase
3. CONTRACTOR or BUILDER'S Address
RD # 1
Glens Falls , New York
4. ARCHITECT'S NanM
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5. ARCHITECT'S Address O
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6. TYPE of Construction — (flame Indicate by X)
( ) Wood 'Frame l } Masonry ( ) Steel
7. PLI and Specifications 1000 gallon septic tank per plot and application �
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No. Submitted .
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a. Proposed Use >
Sewage alteration for dwelling l-A
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Sept . 6 19 $ 7 w
$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES �
(If a longer period is required an application for an extension must be made to the Building and Inning inspector of the
town of Queensbury before the expiration date.?
Dated at the Town of QueenslwrY this 6th Day of
Sept - 19 85
for the Town of Queensbury
SIGNED BY fY s
- Buildi ng and Zoning ng I nsUactor
TOWN OF QUEENSBURY
Building Department
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�pax�ors ""(: ,�,Ar-{
L.oca�son C tx�G [ cof
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Per No. "r
ms!
Remarks
Will
ExcatJ�a tion
Footin Forms
Footin & piers
Foundation
cement Coat
water roofin
Racicfill
Final Surve
Framin
Sheathin
Roof Felt
Roofin
Siding
Masonr Veneer
Rau h PI
Relief Valves
Wall Board
Ext . Porches
Finished Floor
,nter.i.dr Trim
,Stairs & Railin Is
Cellar pro Tile F
concrete Floors
,PI . Fixtures
Gar . Fare roof-in
,poor Closers
Chimne
Water Meter Inst . _.
Se tic A royal
Floor's
Foundation _insulation Walls
CO2 in �-^—
Y
Buil ng Inspector
REMARKS
01
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TOWN OF QUFFNSBURY LMNSSURY
BUILDING i 'ZONING DEPARTMENT I VIE
SEWAGF DISPOSAL PERMIT APPLICATION ij 5
M 4:1!;�fne
1 . Owner ' s Name e ismi � o ,• r +v
" -4 a ►
Address.— _� _ r rd As
Telephone No . _ :2 qc"5/._.S
2 . Property location Si'z
3 . Name of person or firm responsible for installing system �Gr
JF _ Telephone No .
Addressd'`1
4 . Number of bedrooms ( residential buildings Only ) 3
so Daily flow gallons/day
6 . Septic tank capacity /fir . gallons
7 . Topography f t, --dollingr steep
of slope /
so Nature of soil and dept3x_ 4L r✓ A r►�
96 if ground water , bedrock or impervious material is ,apparent at- what
depth does it7 begin? � - ft .
10 . Percolation test : A is required
B. not required.
C I required what is the rate minutes/inch
ll . Water supply : municipal well other
12 . Type of system proposed : dryweil •' 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 s gnature o�ia'pp can
On separate sheet of paper submit a ddiaQraam' of the proposed septic systersn
with all dimensions , including distance from any structure , distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself .
Lam.--. .�
Form 3-82
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