1985-626 BUILDING PERMIT
TOWN OF QUEENSBURY No. 5_ 626
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Steye Bush
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OWNER of property located at Street, Road or Ave. En
r
in the Town of Queensbury, To Construct or place a Sewage Al T ' o
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 . OWNER'S Address is RD # 3
Glens Falls . New York.
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2_ CONTRACTOR or BUI LOER"S Name
Jay Sweet
Queensbury Sewer
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3 CONTRACTOR or BUILDER'S Address
4_ ARCHITECT'S Name
6. ARCHITECT'S Address
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6_ TYPE of Construction — (Please indicate by X) E
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wood Frame 1 1 Masonry l I Steel m i I
7. PLANS and Specifications rt
1000 gallon tank , list . box and 130 ' leach field . m
No. p+
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B. Proposed Use
Sewage system for dwelling
$ 10000 PERMIT FEE PAID - THIS PERMIT EXPIRES Oct . 25 19 87
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queanskwry hefore the expiration date.)
Dated at the Town of Queensbury this 25tY7 Day of
October 19 85
SIGNED BY ° for the Town of Queensbury
Building and Zoning Inspector '
TOWN OF OUFFNSBURY TOWN OF Q[lr=F[NSt3URYY
BUILDING & ZONING DEPARTMENT luJ L`I L�
SETr?AGE' DISPOSAL PERMIT APyPLICATI s� 4 1{yy��r
,Wei
1 . Owner ' s Name / v
4 / (J 0-Of- i ! CJ �T . E 1 f i • E
Address
/ Telephone Noe
2 . Property location
3e Name of person or firm responsible for installing system.
Telephone No . 5T7`
Address
9 , Number of bedrooms (residential buildings only )
5 . Daily flow gallons/day
6 . Septic tank capacity _x gallons
7 . Topography : �ra rolling , steep
of sloe
80 Nature of soil and depth NCO-
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
Ile Water supply : unicipa�, well , other �-
12 . Type of system proposed : drywell< `-1ile fie'lr ,, 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 -
,! sig(natuore o applicant
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 .
Pp
Form. 3 - 82
TOWN OF QUEENSBURY
Building Department
N �Re�
Domer 'V
ame
Permit No. Wcwt6er
Remarks
ExcatYa tson
Footing Forms
Footing & Piers
Foundation
Cement Coat
water roofln
Backfill
Final Survey
Framing
Sheathin
,Roof Pal
Roofi.n
Siding
Masonx veneer
RoUcTh Plbg
Rellef Valves
Wall Board
Sxt . Porches
Finished Floor
Inte. lor Trim
stairs & I2allln s
Cellar Dr . Tile
Concrete Floors
P,Ibq . Fixtures
Gar . Fire roofin
Door Closers
chimney
Water Meter Znst .
Se tic Approval
Floors _
Insulation Foundation _._...._�
_ wasss
Ceisi.rl
Building Inspector
REM"KS
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