6155 BUILDING PERMIT
TOWN OF QUEENSBURY ' No. 6155
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Michael LeBlanc
OWNER of property located at Warren Lane Street, Road or Ave. n
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. C
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1. OWNER'S Address is R. D. #3
Glens Falls, N. Y. o
2. CONTRACTOR or BUILDER'S Name
Carl Dingman .- Reliable Sewer Service
3. CONTRACTOR or BUILDER'S Address
R. D. #3
Glens Falls, New York n
4. ARCHITECT'S Name N
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( 1 Steel ( )
7. PLANS and Specifications Cl)
1000 gallon con. tank, dist. box,80 ' tile field fD
No. per application submitted.
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8. Proposed Use. by
H
Sewage system for dwelling
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$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Feb. 1 1980
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(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 26th Day of October 19 79
SIGNED BY O• /..Z.c2-70s for the Town of Queensbury
Bu Iding and Zoning Inspector •
TOWN OF QUEENSB "•
RECEIVED
TOWN OF QUEENSBURY
BUILDING AND ZONING DEPARTMENT CT 2.✓7 ��
BAY AND !IAVILANSTD ROADS, R. m g� f .M
GLENS- FALLS, NEW YORE 12Q 01 g ROMI-FP- 213 4I 5 6
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APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE
A SEWAGE DISPOSAL SYSTEM WITHIN THE T( N OF .OUEENSBURY
OCCUPANT'S NAME %�,/(a �-{` 6 4.in C a!' s ADDRESS W y!t r
TELEPHONE OWNER'S NAME
ADDRESS rrUr'TBER OF BEDROOMS 2_
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 6YSTEM
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OTHER PERTINENT INFORMATION od 6 4, -fre�'y
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IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVED,
INSTALLATION OF SEvAGE DISPOSAL FACILITIES WILL BE MADE IN ACCORDANCE
WITH DETAILS SHMtL.
DATE L,A49 Si.GN :.TU'HF OF APPLICANT •
LAKE GEORGE PARK COMMISSION APPROVAL
�� , (date)
(.,66-
VJti`
TOWN OF QUEE SBURY
• Building- Department
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Inspector Report L /d/ca..f/7
Name hi i K.€ G cY % J rri A.-i4 L-
Location L I o t
Permit No. C / £ Weather
Remarks
Excaaton
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
_ Roofing
Siding
Masonry Veneer
Rough Plbg.
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 .1
FloOrs l
Foundation
Insulation Walls
• Ceiling
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Building Inspector
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REMARKS
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