1487 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 1487
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Glen E. Powell
OWNER of property located at East Side Bay Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage System
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.
1. OWNER'S Address is
Bay Road
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
J. Sweet
3. CONTRACTOR or BUILDER'S Address
R. D. #1
Lake George, New York
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( 1 Masonry ( )Steel ( 1
7. PLANS and Specifications
No. 1000 gal. tank & dry well 51)
8. Proposed Use 7d
O
Ib
Sewage System
$ 5.00 PERMIT FEE PAID-THIS PERMIT EXPIRES 12-1- 19 71
(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 18 Day of October 19 71
SIGNED BY S2..e- ' r the Town of Queensbury
Buildings Zoning In ctor (0 ,471, )tT L!"f7
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Application for
A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A SEWAGE
DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE WITHIN THE
TOWN OF QUEENSBURY
Mail or bring this application to :
Building 8 Zoning Department
Queensbury Town Office Building
R.D. 1 Bay Road
Glens Falls, New York 12801
This application for a Sewage Disposal Permit must be
accompanied by a plot plan drawn reasonably to scale
showing all dimensions , the size of the lot, the location
on the lot of the water supply and sewage system.
1. Name and mailing address of applicant :
Glen E. Powell
Bay Road, Glens Falls, New York
2. Specific location of property: East Side of Bay Road
(STREET AND NUMBER)
3. Application is for:
New construction of private dwelling .
Alteration or enlargement of existing sewage disposal system.
4. Description of building:
a . number of bedrooms
b. garbage grinder
(YES OR NO)
5. Topography:
(flat, rolling, steep slope, gentle slope, etc. )
6. a. Nature of soil. (Describe to a depth of 5 feet if tile
field is to be used or 10 feet if leaching pits are
proposed, giving thickness of various strata such as
top soil, clay, loam, sand, gravel, rock, etc. )
b. How determined?
7. a. Soil percolation test made by
(Refer to Part III , Bulletin 1 , N.Y.S . Department of Health)
b. Percolation test notes submitted?'
(YES OR NO)
8. Proposed sewage disposal system indicated on attached plan or
sketch?
(YES OR NO) 1000 gal. tank & Dry Well
9. Date when construction will commence
It is hereby agreed that if this application and attached plans
dated or any amendment or reviion thereof ,
are approved, inst— aTlationn of sewage disposal facilities will be
made in accordance with the details thereof as shown on such
approved plans.
r r`
Installed By: Contractor - (`' gnature of applicant)
Owner