The western terminus of the route is at NY 104 in the Oswego County village of Mexico.

The eastern terminus is at NY 5A in the Oneida County village of Yorkville, just west of Utica.

[3] Afterwards, the highway leaves the village and re-enters the town, crossing through more farmlands and lakes.

Route 69 intersects with more county roads as it heads eastward towards Amboy Center.

[3] Route 69 enters Annsville and Taberg, where it intersects with a couple of county roads.

The highway quickly enters Rome and becomes concurrent with Routes 49 and 46 on the southwestern section of the city.

Route 69 turns off after a short distance along NY 365 and continues to the southeast as Rome-Oriskany Road.

The highway heads southward, entering Whitesboro, passing its local fire department memorial park and crossing the New York State Thruway.

Route 28 rejoined modern NY 69 west of Rome and followed it through Camden to Colosse.

[10][11] It was extended eastward in the early 1940s when NY 5S was truncated to its present western terminus in downtown Utica.

The two-lane route begins at US 11 in Hastings and heads northeast to Parish, where it ends at NY 69.