5957 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 5957
1 WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Hel en C. Randolph •
OWNER of property located at iR,C) Chestnut Ridge Road 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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. F✓
1. OWNER'S Address is R. D. #1 (]
Glens Falls, N. Y.
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2. CONTRACTOR or BUILDER'S Name P'
Sanitary Sewer Service
3. CONTRACTOR or BUILDER'S Address -
53 Fourth St.
• Glens Falls, N.Y.
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4. ARCHITECT'S Name
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En
5. ARCHITECT'S Address c-
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6. TYPE of Construction—(Please indicate by X) fai
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( )Wood Frame ( ) Masonry ( 1 Steel ( )
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7. PLANS and Specifications 0.1
placed new pit and #3 stone per application
No. submitted. .
8. Proposed Use
Sewer system for dwelling
$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Nov. 1 1979
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the (D
town of Queensbury before the expiration date.) -
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Dated at the Town of Queensbury this 10th Day of. July 19 79
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SIGNED BY for the Town of Queensbury
0
uilding and Zoning Inspe fiore.
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TOWN 07 (UEENSBURY TOWN OF QUEENSBUR'!
BUILDir ANT) ZONING DEPA:R fit n , van
BAY AND 1TAVILAND ROADS, R o .(LENS FALLS, NEW YORK 12'.- - j L 1979
s A.M: P.M;
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARPE �; ISIB �-1-��2�_3I4I6�6
DISPOSAL SYSTEM WITHIN THE TOWN OF OUEENSBURY
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OCCUPANT'S NAME,/ 61 C/�.. Y;` ADDRESS G -4 12/�
TELEPHONE /Q. 0 ( Cl/e Ty' �'jg?,TIIER'S NAME. ___
ADDRESS d14 NUMBER OF BEDROOMS
GARBAGE GRINDER? . (YES OR NO) TOPOGRAPHY: FLAT, ROLLING:, STEEP,
SLOPE, GENTLE SLOPE,• OTHER
NATURE OF SOIL: CLAY, SANDY, LOAM, GRAVEL, ROCKS, ETC.
PERCOLATION TEST WATER SUPPLY: MUNICIPAL, WELL, OTHER
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DIAGRAM OF PROPOSED SEPTIC SYS M
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4 tOTTER PERTINENT INFORMATION ko- c�
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IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLATS ARE APPROVED,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN ACCORDANCE
rJITH DETAILS HOWN.
DATE /SIGNATURE OF A PLI CAN
LAKE r;EnWIE PARK COMMISSION APPROVAL: L,%e
signature)
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(date)
F--_& h-,,,,,e,v-
TO .N:OF QUEENSBURY
Building Department
Inspectors Report Date .6/
Name.
Location _
Permit No. ----' Weather
Per Cent •
69 ? Complete Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Rough Htg.
Relief Valves
Wall Board
Ext.Porches
Finished Floor
Interior Trim
Stairs&Railings
Cellar Dr.Tile
Concrete Floors
Plbg.Fixtures
Gar.Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Building Inspector
REMARKS
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