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5957 BUILDING PERMIT TOWN OF QUEENSBURY No. 5957 1 WARREN COUNTY, NEW YORK Lk" 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. sy 2. CONTRACTOR or BUILDER'S Name P' Sanitary Sewer Service 3. CONTRACTOR or BUILDER'S Address - 53 Fourth St. • Glens Falls, N.Y. • 4. ARCHITECT'S Name n (D En 5. ARCHITECT'S Address c- - rt 6. TYPE of Construction—(Please indicate by X) fai O ( )Wood Frame ( ) Masonry ( 1 Steel ( ) O 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.) - N rl- Dated at the Town of Queensbury this 10th Day of. July 19 79 rt. SIGNED BY for the Town of Queensbury 0 uilding and Zoning Inspe fiore. r 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 --------- -' 2e4*— 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 ___- DIAGRAM OF PROPOSED SEPTIC SYS M ;c: v)\1,_ L 7 y , 1 • ll______4 a &_cei Pce)6___Qy 4 tOTTER PERTINENT INFORMATION ko- c� cii-3,--ia, _ _ _ _ ____ 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) &-'/. (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 r 3_142, •