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1985-597 BUILDING PERMIT TOWN OF QUEENSBURY No. 8 5- 5 9 7 WARREN COUNTY, NEW YQR K m PERMISSION is hereby granted to Mecleta Wolcott (D rt- OWNER of property located at 55 Dixon Road Street, Road or Ave. w in the Town of Oueensbury, To Construct or place a Sewage Alteration O at the above location in accordance to application together with plot plans and other information hereto filed and o (7 approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. rt rt 1 . OWNEWSAddressis 55 Dixon Road Glens Falls , New York 2_ CONTRACTOR or BUILDER'S Name I.n t..n D . Granger and Sons W r- 3. CONTRACTOR or BUILDER 'S Address 0 19 HOMER Ave . Glens Falls , New York 0 to 93 Ii 4. ARCHITECT'S Name 5, ARCHITECT'S Address [I] 6. TYPE of Construction -- (Please indicate by XI ly I ) Wood Frame ( ) Masonry I 'Steel ( ) `CD fCl 7. PLANS and Specifications rt- No. 7 ' x7 ' drywell per plot and application submitted . CD >y rr w- S. Proposed Use 0 One ©Family Dwelling $ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES Oct . 16 1987 (If a longer period is required an application for 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 16th Day of �Oqc_ t • 19 85 SIGNED BY for the Town of Queensbury " IBuilding and Zoning Inspector �� TOWN OF 0UrrNSBURy TON OF GUEENSSURY ii BUILDING i ZONING DEPARTMENT iliRU rf3 fps EV t G ( SEWAGE plSposzL4 PERMIT APPLICATIONOCT 5 W5 I . Owner ' s Name Address 5" r �•.. 17 � a16 IL � w- Telephone No 2 . Property location S ^4 3 . Name of person or firm responsible for installing system Telephone No . _�,} r7 � 0 Address Iq 4 . Number of bedrooms (residential buildings only) 1 5 . Daily flow' Jp crallons/day _ 6 . Septic tank capacity 4" - gallons 7 . Topographys flat , oiling , steep . of slope so Nature of sail and depth. ��,t 9 . If ground water , bedrock or imperviousmaterial is apparent at what depth does it obegin2_ / � fte l0 . Percolation test : A is required S is not required C If rbclulred what is the rate minutes/inch 11 . W � suPPly =� nicipal , well. , other 12 . Type of system proposed : dell , tile field , other Any ,contractor ,. corporation , individual , etc . engaged In * the construction of a sanitary sewage disposal system who covers the same before inspedti.on , does not have an approved permit , or varies from the approved application will be subject to a penalty of $ 250 as provi d for iZSe icon. 6 . 010 of the Queensbury Sanitary Sewage Ordinance , Date_ eI a /,� f �`" signatureIA - ' app l ant _ On separate sheet of paper submit at 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 . Form 3 - s2 4 ttK w ' { � �.. a ��►c k / e ,r Vw ma`s �