1304 BUILDING PERMIT
TOWN OF QUEENSBURY tri
No. 1304 S
�o J 30z \ � WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Pliney Tucker
OWNER of property located at R. -Division Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage system
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
R.D.#2-Division Road-Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Self d
3. CONTRACTOR or BUILDER'S Addresscn
H
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4. ARCHITECT'S Name 9
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
3 bedrooms-topography-=-flat-Soil--gravel
No.
Dry well 1500 gallon as per submitted plans & specs.
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8. Proposed Use y
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septic system
$ 5.00 PERMIT FEEPAID —THIS PERMIT EXPIRES 8-1-71 19
(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 13th Day of July 19 71
SIGNED BY for the Town of Queensbury
Building and Zo g Inspector
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Application for
TOWN OF QUEENSBURY
E 0,)t
A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A S AGES
DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE WI . N 121971
TOWN OF QUEENSBURY
A.M.
Mail or bring this application to: 7�f3�9�10'11�12,II2�3+4(5�6
{ { { l l 3 l { F { 4J
Building 8 Zoning Department :r A
Queensbury Town Office Building
R.D. 1 Bay Road
Glens Falls, New York 12801
This application for a Sewage Disposal Permit must be
accompanied by a plot plan drawn reasonably to scale
showing all dimensions, the size of the lot, the location
on the lot of the water supply and sewage system.
1. Name and mailing address of applicant:
•
" u�� 1� p, ,4` Z V 1 () /s /c .c� se cz
l'ce-/c)s ,-. L/s /C9 y .
2. Specific location of property: V 12 i) S fo
(STREET AND NUMBER)
3. Application is for:
New construction of private dwelling .
Alteration or enlargement of existing sewage disposal system. K
4. Description of building:
a. number of bedrooms 3
b. garbage grinder 4.) 0
(YES OR NO)
5. Topography: /9- /~
(flat, rolling, steep slope, gentle slope, etc. )
6. a. Nature of soil. (Describe to a depth of 5 feet if tile
field is to be used or 10 feet if leaching pits are
proposed, giving thickness of various strata such as
top soil, clay, loam, sand, gravel, rock, etc. ) 7s u 2
b. How determined?'
7. a. Soil percolation test made by •
(Refer to Part III , Bulletin 1 , N.Y.S . Department of Health)
b. Percolation test notes 'submitted?
(YES OR NO)
8. Proposed sewage disposal system indicated on attached plan or
sketch?
(YES O`R NO)Ptpe f 4./1
9. Date when construction will commence
It is hereby agreed that if this a_p{_ lication and attached plans
dated or any amendment or revision thereof,
are approved, installation of sewage disposal facilities will be
made in accordance with the details thereof as shown on such
approved plans.
Installed By: Contractor - 'ignature f applicant)
Owner