6159 BUILDING PERMIT
TOWN OF QUEENSBURY 6159
No.
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Harrisena Community Church
OWNER of property located at Ridge Road (Manse) 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 N
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is Star Route C�
Glens Falls, N. Y.
5
2. CONTRACTOR or BUILDER'S Name �t
N.
Action Septic
3. CONTRACTOR or BUILDER'S Address
Fi
C)
5 Spruce Court
Cl1Pns Pal 1 .s, N_ Y_
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
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1 1 Wood Frame ( ) Masonry ( 1 Steel ( )
0
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7. PLANS and Specifications ¢'
1000 gallon tank, dist. box and 240' tile field per
No. application submitted.
8. Proposed Use CD
Sewage system for dwelling
$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Feb. 1 19 80
(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.) i
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Dated at the Town of Queensbury this 2 6th Day of October 19 7 9
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SIGNED BY .412-4 6 �' for the Town of Queensbury n
Build* and Zoning Inspector
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TOWN OF QUEENSEurc ,
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O REnV
OCT 4MY/9
A.M. 5 re-e a '
MIMII-AlAnMW19
TOWN OF QUENSURY
BUIY,III.q.0 AND 0"Fri'M DEPARTMENT
DAY AN) HY7ILAND ROADS, R. n. P
GLENS PALLE, NEW YORX 12801
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARCP
A SEWAGE DISPOSAL SYSTEM WITHIN T4E TOWN OF OTTEENSBURY
OCCUPANT'S NAME .--1cALR 1\AC.d.,-11 . ADDRESS
TELEPHONE OWNER'S NAME___4 cuvt C.1..0 V-C-k.
ADDRESS '-R Jr_(. c>. --c-a--4 'NUMBER OF FDNJ
GARBAGE, GRINDER? (YES OR NO) TOPOGRAPHY: LAITc7 .OLLING, ST=P SLO ,
GENTLE SLOPE, OTHER
NATURE OF SOIL: CLAY, O21DY,__ GRAVEL, ROCKS, ETC.
PERCOLATION TEST WATER SUPPLY: MUNICIPAL, WELL, OTHER
DIAGRAM OF \OPOSED SEPTIC SYSTEM
(t-f ctf t- 17
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'12-1-7A1/ ci-
.
OTHER PERTINENT INFORMATION
IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVEr',
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN ACCORDANCE
WITH DETAILS SHOWN.
OW
DATE IA - --- SIGNATURE OF APPLICANT 4._
LAKE GSORGE PARK COMMISSION APPROVAL: I- "-
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date y/3/7 9
Name Ha► e i S e n G Ch(r( Yh,a n S "e r
Location Rid,. �Pcl- a Lie R.i /'9/
Permit No. ` / 9 Weather
Remarks
Excattation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing 4
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board J
Ext. Porches
Finished Floor j
Interior Trim
Stairs &Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures I
Gar. Fireproofing 1
Door Closers
Chimney
Water Meter Inst.
Septic Approval e,<N
Floors
Insulation Fcu.ndaticn
Walls
Ceiling
Build g snector
REMARKS
per 0n se r, S CO/7 T,-q cTar