8575 BUILDING PERMIT
TOWN OF QUEENSBURY No. 8575
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Roger Ryan
OWNER of property located at Hall Road, Glen Lake Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and 0
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is R. D. #1 ,b
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Frank Shaw
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name 0
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5. ARCHITECT'S•Address H
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6. TYPE of Construction—(Please indicate by X) (D
( ) Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
1000 gallon septic tank, dist. box and 175 ft.
No. tile field per plot plan and application
submitted. rn
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8. Proposed Use W
Sewage system for dwelling ID
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10. 00 June 18 86 tD
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
1•-'-
town of Queensbury before the expiration date.) p
Dated at the Town of Queensbury this 18th Day of June 1984
SIGNED BY 711de% a• for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT TowN OF QUEENSVURY
SEWAGE' DISPOSAL PERMIT APPLICATION ® E IF II V E �f
1. Owner ' s Name ,0 � � is
Address 4-2 /J /1, . �
fi o "-/ Cis /= I/'S,/i 1109te ll tZtd14)5 6
4_{_t_
Telephone No. e,
2.. Property location / ,' L J
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3 . Name of person or firm responsible for installing, system /EE, '
/ 4-4., Telephone No.
Address
4. Number of bedrooms (residential buildings only)
5. Daily flow lc - ) gallons/day
6. Septic tank capacity jC0 gallons
7. Topography: flat, rolling, steep
of slope :gloy,i i
8. Nature of soil and depth
9. If ground water, bedrock or imperviou material is apparent at what
depth does it begin? 69.— S ' ft. Cm' Fr66
10. Percolation test: A is required
B 0 is not required
C If required,what is the rate minutes/inch
11. Water supply: municipa ether
12. Type of system proposed: drywel , the 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 proy' d for in Se 'on 6 .010 of the
Queensbury Sanitary Sewage Ordinance. /
Date 1V,J1S7?
/ sic; ur of ppl cant
On separate sheet of paper submit a diagram of the propo ed 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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