1985-500 BUILDING PERMIT
TOWN OF QUEENSBURY No. 85- 500 0
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Donna Lozo N
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OWNER of property located at =_ _ -- - _---- _ _ • Q { T{�h Street, Road or Ave-
in the Town of Queensbury, To Construct or place a Sewage sy'stern for mobile home
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_
1 . t7WNERSAddress1s 135E Eisenhower Ave .
Glens Falls , New York
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2. CONTRACTOR or BUILDERS Name �
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George M . Mabb
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3. CONTRACTOR or BUILOER'S Address :
105 {]Peer Sherman Ave .
Glens Falls , New York E
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4. ARCHITECTS Name pi
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5_ ARCHITECTS Address
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6. TYPE of Construction — IPleam indicate by X1
[ I Wood Frame ( I Masonry ( 1 'Steel ( f
7. PLANS and Specrfications
1000 gallon septic tank , list . box and 2 - 5 ' x8 ' drywe is with
No. # 2 stone per plot plan and application submitted . �
S. Proposed Use 0
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Sewage system for mobile home dwelling F - m
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$ 10 , I] C) PERMIT FEE PAID — THIS PERMIT EXPIRES Sept- 4 yg_-8_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 Queenslhury before the expiration date_)
Dated at the Town of Queensbury this 9th Day of September 19 85
SIGNED BY for the Town of Queensbury
Building and Zoning I nspector
TOWN OF QUEFNSBURY
BUILDING & ZONING DEPARTMENT 'Town OF QQuEr=NSBURY
SEw.AGF DISPOSAL PERMIT APPLICATION FE E 0 -V E D
1 . Owner ' s Name 2 eD coy r
Add r e s s /_ A.we. 0(0 B,
Telephone No .
2 . Property location 1_ } r r .-x AD U
3 . Name of person or firm responsible for installing system
Telephone No . 72
Address L? 3G / a j~ (t i-r
4 . Number of bedrooms ( residential buildings only) 3
5 . Daily flow gallons/day
6 . Septic tank capacity ,� � � 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 .
lo . Percolation test : A is recauxred
B is not required
C I required what is the rate minutes/inch
11 . Water supply : municipal , well , other ;mow , ,, U;..V, ;4 r r
12 . Type of system proposed : drywell , the field , other
Any contractor , corporation , individual , etc , engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection ,
sloes 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 ! : Z'a
LJ f~signature of app icant
On separate sheet of paper submit a dd�ia_��r��a� m 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
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