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99-667 �_ TOWNOF QUEENSBURY ir* 742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: 99667 Date Issued: Wednesday, October 04, 2000 This is to certify that work requested to be done as shown by Permit Number 99667 has been completed. Tax Map Number: 523400-006-000-0003-022-000-0000 Location: 18 HARDING Ln Owner: THOMAS HARDING This structure may be used as a: 242 Sq. ' Dock By Order of Town Board TOWN OF QUEENSBURY ('- efA14 1/ Director of Building& Code Enforcement BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury,NY 12804 County of Warren (518) 761-8256 VALUE $ 5 000 Building Permit No. 9 9 6 6 7 TAX MAP NO. 6 . -3-22 Permission is hereby granted to HARDING, THOMAS Owner of property located at 18 HARDING LANE in the Town of Queensbury,to construct or place a DOCK at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Owner's Address: 15 HARDING LANE LAKE GEORGE, NY 12845 Contractor or Builder's Name: HARDING, THOMAS Contractor or Builder's Address: Electrical Inspection Agency: Type of Construction: DOCKS Plans and Specifications: 242 SQ FT DOCK AS PER PLOT PLAN SPECIFICATIONS Proposed Use: DOCK $ 30 PERMIT FEE PAID—THIS PERMIT EXPIRES November 1 2001 (If a longer period is required,an application for an extension must be made to the Code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the T of Queens this 1 Day of November 1999 SIGNBL BY for the Town of Queensbury Code Enforcement Officer ; TOWN OF QUEENSBURY Fee r 1104 BUILDING & CODES DEPAR'TMENI' . APPLICATION FOR: PORCHES-DECKS- Permit II • • DOCKS & BOATHOUSES Est. Cost C— A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. PLEASE ANSWER ALL OF •fllE FOLLOWING: The undersigned hereby applies for a Buildings Permit to do the following work which will he done in accordance with the description, plans and specifications submitted, and such special conditions as may be indicated on the permit. •IWO SETS O1= STRtlClUUA1. PLANS SHALL BE ';UIIMIIII:I) WITii T11IS APPLICATION. Owner of Property: LAUo, ,,„a_R G, P.O. Address L L: v,€_ 4 L 1 '-' i z_V E Phone Il 1,0 Property 'Location so-,Axik favd, ' fAc: -i. Tax Malf 11 Subdivision Name (If applicable) PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES: Name: ' , ".--kai31,,d Address • Awave i►Ilune ,56__ cc- BUILDING SPECIFICATIONS: •• Type of work to bb done: Porch Deck Boathouse (Circle one) Size of Structure to be built (square footage): zy2 t t fi' ;t ,.0 4o--.4,..,.,e ,4.,,t, Foundation Material : Width Thickness -^ C 1.42 Depth of Footing, below grade: Size of Posts or Studs: x x Long Size of Floor Joists: x x Span Decking or Flooring Material : c.43 .7- >7 6 ax Ilow will Porch or Deck be fastened to building? If Roof Will Be Installed, Answer Following Questions: OCT fo 1999 Size of''Posts or Studs: x x Long Roof Rafters: x Spacing Span Roof Trusses (pre-engineered spacing): Span Type of Roof: Sloped Flat Shed Other (Circle one) Malarial of Roof: ZONING INFORMATION: TWO PLOT PLANS MUST BE PREPARED ANU SUM I TIED, drawn reasonably to sc;rle and all:ache,) hereto, sho iTiiircloar y urtrnilii'ts liiclly n�l"1—lii-fldiirijs, whether cxIsLin„ or p row)seil aoil indicate a•l1 set back dimensions Irons property 1Ines. Show 1 uca Lion of water- supply and location and configuration of septic disposal area. --� Size of Property: 1 , s L ft. x Existing building(s) : Size ft. x ft. Size ft, x ft. Use of Existing building(s) : Proposed structure, distance from property line: Front yard ft, Rear yard ft. Side yards . ft. and :too ft. If on corner, setback from side street: ft. • DECLARATION To the best of my knowledge and belief the statements contained in this application, together with the plans and specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the Building. Code, the Zoning Ordinance, and all other laws pertaining to the proposed work shall be complied with, whether specified or not, and that such work is author zed by the owner. 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'ztfs...3. . 5......, li ‘I 1 ...--- -,r ..._ oo ...,-„,...,;...... ." ® SUPPLY / 8.5-12 ® SCUOERI / 8.-6-8.2 ® LAPAIA / 8.5-14 © HOPPER / 8.-6-5 © HADIG / 8.-5-16 OO VERDRAGER / 8.-6-2 (ID FRASER / 8.-5-16 0 DALTON I 8.-6-9 O OILLON / 8.-5-20 © MUNHALL/ 8.-4-3 © SULLIVAN / 8.-8-5 O ALLEN / 8.-4-2 © RITANO / 8.-8-6 O BODENHORN / 8.-4-4 ® MOLINARO / 8.-8-8 0 PARISI I 8.-3-7 © MURRAY 18.-8-IC © CHRISTOPHER / 8.-3-6 `.l LOUIS / 8.-8-1.2 ® LEJUEZ / 8.-3-2.4 OK DIEHL / 8.-8-2 ® BAERTSCHI / 6.-2-I5 © LEJUEZ / 8.-8-4 O MCMULLEN I 6.-2-4 0 CHRISTIE I 6.-2-3 H A R R ] LYNCH MORSE 9.-1-22 9.-1-19 RUSSO BINLEY POLANSKY 9.-I-2T PROVENZANO SCHWAB 9.-l-IS PHAFF 9.-1-21.1 _ 9.I-31.2 9.-1-�0 9.-1-28 FRE[HOFER BOONAR a CAFFRY 9.-1-30 SCHWAB 0"KEEFE 9.-I-21.2 9.7119 9.-t-31.1 MART IN/MET IVIER 9.-1-17 -1 TURNER MORRIS 9.-I-33 9.-1-23 9.-1-32 STEW4RT \ RHONE 8E SL 6 CURTIN 9.-1-16.2 y 9.-t-3a 8.-5-13 --} + I • JAPPELL AMIR-SHEER 40AM \ `• PRONTI _ �I • 9.-I-35 8Y(ZO 4SKI d.-5-d 8.-5-t( WOODRUFF 8•-O HEMENWAY 9'-5-IS BENJAMI 8.-5-10 LARAIA NEMITH 3.-Z-6 8._5_17 "- GRIDLEY , 9._1-26 CHON�WOIf =RIOLE 3_-a-8 ROSS 9.-l-2s CARTE A( 9.-I-t6.! / 9.-i-25�\ ��__ -19 9. LESTER OTYQKWA - ' 9.-1-I5 GROB BIRNEY • 9.-2-1 •OTYOKWA �8.-5-t 9.-I-la 9.-!-36 A CORNELL • �4 Y NON=Y^ (P (P ® i• r `9.-1-13 ' • V4UGHN r ` VEEDER ORTEZ 8.-2-12• ? 9.-I-12 •9.-t-37 CEq ZYLOWSKI Q- (��, • �? �, • K. ADAMSON Q4.� v •9RAN38R 8. •2-4 vry" •, • �DU9[N • C. AOAMSON • OTYOKWA +0 �� 1.CL RK 9l 9.-1-10 _./9H-t-a N •9.-!-39 t TRaIN4 .� t • '189-7 7. 9OFF SERAFINT • 4. 8.-3-4 10 V t SHERMAN • d.-Z-B Ir �, t B'cNDt __ _� LEESER t • 9 ! _ 9__�-7 I / PARISI SMITH / ? �Q '3.-96 TAYLOR I ; 8•-2-7• KILLEEN 8.-6-1-2 I � A 9.-1 B 1 { r 8 -! OLSON 1 p Ma-LM4N ECKARDT ^pR 8-6 10 � -a-- 9.-I-5 /E 4GLERT' • FSJ- A TRILL (9 -!-3 • TEOESCH[ .0 / BURKE / • 4., 3-I-29 • •p BRUEN(NG 8.-9-: LEINOF JF` ERVIE jCG131EN 4Q 3.-3-t2 MANN I • WILCO 9.-I-t KLEIN .-1-33 MALONEY 8.-1-Z i / t • �B.-I-35 HOGAN_ / 1 \DONNE 8.-1-3 8.-1-34 STONEI • -ARIELLO 8.-1-4 t STARK • 3.-t-15 8.-t-J • i TOBIN BROWN • KEYS 8.-1-5 8._1-8 ; 8 E-17 OWEN HUBERT / • • \ • 8.-I-6 8.-I-9 SEBOLD • • • OSE! 8.-1-10 HEATH 7.-1-t HARRISON 8.-1-13 1 DESOR1 8.-1-I1 7.-1-5 H[TEG IV ER WHITMORE W WHITE 8.-:_.4 MACELROY AHLERS 7.-1-4 LANGFORD 7.-i-3 9.-1-16 HOLMES HARRINGTON 7.-1-2 7.-1-! LAKE GEORGE 1 UPDATED - JULY 1993 D.M. MAP OF ASSEMBLY POINT UPDATED - JULY 1996 D.M. TOWN OF QUEENSBURY JULY 1990 APPROXIMATE SCALE: 1 ` = 500' 1 ^.ncvnu,VOI*OruyVr.u+o neu LAKE GEORGE PARK COMMISSION a (:, 0' n> .•1r,. I:, , 75 FORT GEORGE ROAD �1 P.O. Box 749 LAKE GEORGE, NEW YoRK 12845 - �E_s�r www.superior.net/—lgpc CARL R. DE SANTIS MICHAEL P. WHITE Chairman Executive Director November 5, 1999 Thomas Harding RECEIVED 15 Harding Lane Lake George NY 12845 NOV 0 8 1999 RE: Wharf Construction Permit #5234-32-99 TOWN OF QUEENSBURY Excavation/Fill Permit#5234-33-99 PLANNING OFFICE Dear Mr. Harding: Enclosed is your permit which was issued in accordance with the applicable provisions of the Park Commission's rules and regulations (6 NYCRR 645 & 646) and Article 15 of the Environmental Conservation Law relating to excavation and/or placement of fill. Please review the general and special conditions included in the permit; these are intended to minimize any environmental disturbance associated with the authorized activity. The Article 15 approval was issued under a special delegation agreement with the Department of Environmental Conservation who normally issues these approvals. This eliminates the need for separate application forms and fees which would otherwise apply to this project. Please note that it is the responsibility of the permittee and the permittee's agent to comply with all permit conditions. Further, the permit is valid only for the activity expressly authorized. Work beyond the scope of the permit shall be considered as work without a permit. The notice enclosed with the permit must be displayed in a conspicuous place near the project site during the entire period of construction and must be suitable protected from the elements. Any failure to comply with the terms of the permit may be treated as a violation of the Environmental Conservation Law. Questions regarding this permit should be directed to the undersigned. Should your plans change, you must contact this office to determine whether a modification to the permit is required prior to initiating construction. Please note the expiration date of the permit. If further time is required to complete the project, you must request renewal of the permit prior to this date. Your interest in maintaining the environmental quality of Lake George is greatly appreciated by the Commission. Sincerely, L1 74,7(/6 -A-14-A- Molly Gallagher Deputy Permit Administrator Enclosure cc: LGPC Law Enforcement Town Supervisor Shawn Callahan TELEPHONE(518)668-9347 E-MAIL:Igpc@superior.net FACSIMILE(518)668-5001 M:\USER\MOLLY\FORM\PERMITDOCKMOOR LAKE GEORGE PARK COMMISSION LGPC PERMIT NUMBER EFFECTIVE DATE ' f: 5234-32-99 DM 'Al_i d November 5, 1999 5234-33-99 EF rr:ati: TYPE OF PERMIT EXPIRATION DATE New PERMIT o Renewal November 5, 2000 Under the Environmental Conservation Law (ECL! ❑ Modification o Variance X Article 43, Title 1, 6NYCRR 646-1.1 Article 43, Title 1, 6NYCRR 646-1.1 Construction and Modification of Wharfs Placement of Moorings X Article 15, Title 5, 6NYCRR 608 Article 43, Title 1, 6NYCRR 646-1.2 Use and Protection of Waters Operation and Modification of Class A Marinas Article 43, Title 1, 6NYCRR 646-1.4 Article 43, Title 1, 6NYCRR 646-1.4 Recreational Use- New Recreational Use- Parasail Article 43, Title 1, 6NYCRR 646-1.4 Article 43, Title 1, 6NYCRR 646-1.4 Recreational Use-Seaplane Recreational Use-Tour Boat Article 43, Title 1, Section 43-0117 Operation of ferries and Article 43, Title 1, 6NYCRR 646-4 certain other boats, barges and vessels restricted Stormwater Management PERMIT ISSUED TO TELEPHONE NUMBER Thomas Harding (518) 656-9910 ADDRESS OF PERMITTEE 15 Harding Lane Lake George NY 12845 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Shawn Callahan (518) 761-1272 NAME OF FACILITY(AND ADDRESS IF DIFFERENT) LOCATION Harris Bay COUNTY TOWN PARCEL Warren Queensbury 6-3-22 DESCRIPTION OF AUTHORIZED ACTIVITY Remove a 16.5' X 6' section of wharf and add two piers to an existing wharf to result in a 42' long, 28' wide F-shaped wharf and construct open-sided, rock-filled timber cribs to be used as support for wharfs in accordance with plans attached as Schedule A and made part of this permit and as conditioned herein. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the Environmental Conservation Law, the Navigation Law, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this permit. DEPUTY PERMIT ADMINISTRATOR ADDRESS Molly Gallagher PO Box 749, Fort George Rd, Lake George NY 12845 AUTHORIZED SIGNATURE DATE .6;)4/W4/2 Page 1 of 5 LAKE GEORGE PARK COMMISSION ; GENERAL CONDITIONS 1. All activities authorized by this permit must be in 9. Granting of this permit does not relieve the strict conformance with the plans attached as permittee of the responsibility of obtaining any other Schedule A and made part of this permit. permission, consent, permit, or approval from the Modifications to the project require prior approval in US Army Corps of Engineers, US Coast Guard, NYS writing from the Commission. Office of General Services, NYS Department of Environmental Conservation, NYS Department of 2. The permittee and any contractor, project Health, Adirondack Park Agency, or local engineer, or other person responsible for the government which may be required. overall supervision of this project shall read, understand and comply with this permit, 10. The permittee has accepted expressly, by the including all special conditions to prevent execution of the application, the full legal environmental degradation. responsibility of all damages, direct or indirect, or whatever nature,and by whomever suffered,arising Inspections out of the project described herein and has agreed to indemnify and save harmless the State from 3. The Commission and/or the Department of suits, actions, damages and costs of every name Environmental Conservation (the Department) and description resulting from the said project. may conduct such on-site surveys, investigations, examinations, and evaluations 11. The State of New York shall in no case be liable for from time-to-time as it deems necessary to any damage or injury to the structure or work herein ensure compliance with the terms and authorized which may be caused by or result from conditions of this permit. future operations undertaken by the State for the conservation or improvement of navigation, or for 4. A copy of this permit must be available at all other purposes, and no claim or right to times at the project site during performance of compensation shall accrue from any such damage. the authorized activities. Failure to produce a copy of the permit upon request by a 12. No commercial use, as defined in 6 NYCRR 645- Commission or a Department representative is a 2.1(i), of the permitted dock, wharf or mooring is violation of this permit. herein authorized. Regulatory fees are due April 1 of each year for docks,wharfs and moorings. Permit Modifications & Renewals Environmental Protection 5. The permittee is responsible for keeping the permit active by submitting a renewal 13. Disturbance to the bed and banks of Lake George application, including any forms, fees or shall be kept to the minimum necessary to complete supplemental information which may be required the project by the Commission, no later than 30 days prior to the expiration of this permit. 14. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by 6. Any change or modification in any of the suspended solids, sediment, fuels, solvents, activities authorized by this permit is subject to lubricants,epoxy coatings,paint,concrete,leachate prior review and approval by the Commission. or any other environmentally deleterious materials Any modification of this permit granted by the associated with the project. Commission must be in writing and attached hereto. 15. Heavy equipment, including bulldozers, backhoes, payloaders, etc., shall not be driven in the water. 7. The permittee is responsible for obtaining any other permits, approvals, land easements, and 16. Any material dredged in the prosecution of the work rights-of-way which may be required for this herein permitted shall be removed evenly, without activity. leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may Other Legal Obligations of Permittee have a tendency to cause damage to navigable channels or to the banks of a waterway. 8. This permit shall not be construed as conveying to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work or as authorizing the impairment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit. LGPC PERMIT# Page 2 of 5 5234-32-99 & 5234-33-99 LAKE GEORGE PARK COMMISSION GENERAL CONDITIONS 17. Any debris or excess materials from construction 26. Every dock or wharf constructed shall have a of this project shall be immediately and completely minimum setback of twenty feet from the adjacent removed from the bed and banks of all water areas property line extended into the lake on the same to an appropriate upland area for disposal. axis as the property line runs onshore where it meets the lake, or at a right angle to the mean 18. There shall be no unreasonable interference with high-water mark, whichever results in the greater navigation by the work herein authorized. setback. 19. If upon the expiration or revocation of this permit, Crib Work the project hereby authorized has not been completed,the permittee shall,without expense to 27. Stone used for filling shall be clean (not contain the State, and to such extent and in such time and any material than can pass through a No. 8 sieve). manner as the Commission or the Department may The stone shall not be less than six (6) inches in require, remove all or any portion of the diameter. uncompleted structure or fill and restore the site to its former condition. No claim shall be made 28. No rocks for use in construction are to come from against the State of New York on account of any the lake bed. such removal or alteration. The following specifications apply to the construction 20. If future operations by the State of New York or replacement of rock-filled cribs. Existing cribs may require an alteration in the position or the structure be repaired. or work herein authorized, or if, in the opinion of the Commission or the Department, it shall cause 29. The size of any individual crib shall not exceed 8 unreasonable obstruction to the free navigation of feet by 12 feet. said waters or flood flows or endanger the health, safety or welfare of the people of the State, or 30. Spacing between cribs shall not be less than 8 cause loss or destruction of the natural resources feet. A minimum of 6 feet of open water shall be of the State, the owner may be ordered by the maintained between the shoreline and the first crib Commission or the Department to remove or alter to allow for free circulation of water. the structural work, obstructions, or hazards caused thereby without expense to the State. 31. Completed cribs shall be of the "open-sided" type construction and provide for at least 40% Wharf Construction Specifications unboarded water contact area to the rock fill. The following conditions apply to all newly constructed wharfs which have not received a variance from any of Moorings these limits: 32. Moorings shall be placed so that vessels moored 21 . The location of the mean low water mark must be to them, at the full swing of their mooring or field verified prior to construction. In no case shall anchor line, will be no closer than twenty feet to any part of the wharf extend further than 40' from the projection of the property lines extended into the mean low water mark. the lake along the axis of the property lines as they intersect the lake, or a line extended at a 22. The maximum surface area of any dock or wharf right angle to the mean high-water mark, shall be seven hundred square feet, including any whichever results in the greater setback. walkway. 33. Moorings shall not be placed so that the full swing 23. The maximum width of any pier shall be eight feet of the vessel extends more than one hundred feet and the minimum width of any pier shall be two offshore from the mean high-water mark. feet. 34. Moorings must meet the following minimum 24. The maximum width of any dock or wharf, specifications: At least one cubic foot of buoy is including all lateral projections, shall be forty feet. to be above the waterline; a one inch strip of reflector tape is to be placed around the upper part 25. No structure shall be constructed on a dock, wharf of the buoy; the buoy shall be all white with a one or mooring which exceeds sixteen feet in height inch blue strip placed horizontally around the above the mean high water mark and which is not circumference above the water line. in compliance with local zoning. LGPC PERMIT# Page 3 of 5 5234-32-99 & 5234-33-99 t . I. 3 -� _ w • i " .4• • • stiwC lot _ // / '�� J iiiklif..1/4 � • / I3l' coif r ,sy\)( 7/- ,, o• ,,,N . . ( r i / \ .1: . --' L_. ‘,...)// i 1 ... \- ...r. _ . . \*:::)' \ " 7 • ECEIUED ' . a _- o I • ,'; �� I J LAKE GEORGE PARK COMMISSION _ C. : - ' ' f8 ,-)., : ---... / . _. . .-.,. _-_----A / r '/ - .!! . ,J'a ., G UAL/ 3 Lsft 2.Z \ - -� — �• / / i •r� :.% . '/� �� Page 4 of 5 ' LGPC PERMIT#5234-32-99&5234-33-99 .1 , a A 1:.41 ----/ .'''.'-•I0 _;(1.).,ri.4q.43-2' IaI,llN.,L,.r.,,i'".i'i6Aie,,r11. _-*W-.-,-..-.-.-"m-.i-- LAKE GEORGE PARK COMMISSIr • ..,„±C„.„,„,,,,,,,,__ ,_____ _ _ . ON .-- f-, _ 4 . # 3 W" 3 .;;\ i r , , ._. i 1--, ... , i ,, ,.. - //-7 - `�` 1� •� � , 1� v Ov car r - c S cn j N` ashaa Cu / I \ y ;DNS (� V-4 i •r3 r s r- � -s 12 , non O '�� J Li / :i — ( — f/- co I is II • • --tom Page 5 of 5 LGPC PERMIT#5234-32-99&5234-33-99 �Vf { i State of New York RECEIVED Lake George Park Commission PO Box 749, Fort George Road OCT 2 1 1999 Lake George, New York 12845 Notice of Availability for Review' TOWN NING OFFICE Notice of Complete Application PLANNING QUEENSBURY Date: October 20, 1999 Application: 5234-32-99 Type:DM MINOR Applicant : THOMAS HARDING 15 HARDING LANE LAKE GEORGE, NY 12845 Project Location: TOWN OF QUEENSBURY, WARREN CO. Parcel#: 6-3-22 HARRIS BAY Project Description: REMOVE A 16. 5 ' X 6 ' SECTION OF WHARF AND ADD TWO PIERS TO AN EXISTING WHARF TO RESULT IN A 42 ' LONG, 28 ' WIDE F-SHAPED CRIB WHARF AS SHOWN ON THE PLANS ATTACHED. SEQR Lead Agency: None Designated SEQR Determination: 1 - Type II Action TO INTERESTED PARTIES : Comments Due: November 04, 1999 This notice is being sent to allow you an opportunity to comment on the proposed project . Written comments must be received by the "comments due" date above and should detail specific reasons for your interest, support or opposition. Return this form and any comments to : Molly Gallagher LGPC, Box 749, Lake George, NY 12845 . Phone : (518) 668-9347 . Reviewer Comments : Li No Comments 171 Comments below or attached ( cc : Town of Queensbury M. GRASSO LINDA & PAUL BRADLEY Prepared by: Address : Telephone: ( ) Date: LAKE GEORGE PARK COMMISSION FORT GEORGE ROAD, PO BOX 749 �,, L LAKE GEORGE, NEW YORK 12845-0749 MS, G�� et- phone 518-668-9347, fax 518-668-5001 APPLICATION FOR PERMIT FOR DOCKS, WHARFS • I ! � THIS APPLICATION IS FOR THE: ❑ Construction of a New Wharf ($200) ❑ Placement of a Mooring ( 100 qq 14 Modification to an Existing Wharf($50) ❑ Modification to an Existin Me ►rin58)O Article 15 Excavation/Fill (work below mean high water level as part of Wharf c s e tion -no fee '�e t`1 2_"+`/9 GEORGE PARK COMMISSION APPLICATION FEE ENCLOSED: 3 0 (check or money order only) 1. NAME OF APPLICANT: —IVo L " APPLICANT IS A/AN: Individual Cl Partnership Association Cl Corporation Cl Municipality Agency Street/PO Box: 1 . ����„ �„� City: r.-, State: \V' 't Zip Code: tZ.g Phone( rt8 } 6 C _ cz t O 2. NAME OF OWNER (if not applicant): 3(\lv ,� E 1 Street/PO Box: City: State: Zip Code: Phone: NAMES OF PREVIOUS OWNERS (since 1981): t'va —} h/`„ ' �� ._ 3. NAME OF CONTRACTOR (if known): Sk"..Gtw Cat. 1,1,ci.lAat Street/PO Box: t.3 Z City: l th '.At Bari IZg U ` 61 State: tU Y� Zip Code: Phone: 4. PROJECT LOCATION: SECTION C. BLOCK 5 LOT 2. 2- (parcel tax map number) STREET: j ; L.►-, VILLAGE: („ , . TOWN: 5. ZONING CLASSIFICATION: R•vg.a-.V- 6. NUMBER OF WHARFS OR MOORINGS CURRENTLY ON PROPERTY: A. t,,,I.A.„-q Permit, Registration or Account Number(s): -Z`oc 2- 7 7- 7. TOTAL LAKE FRONTAGE: 1 7 according to ®Tax Map Cl Survey (attach copy) Cl Other (specify) 8. PROJECT DESCRIPTION: Tt e rzwlooecrt o-t` S6 6" c-t -t Cv`ek_ c7 ©IdG�{ten Gtaa -two Z2. Sec 1o,"b' . -ice k.st'c-s (-lost.?G� S AzciA- Ioc t?j to c_ 0(L Y EE dAt- v`_Q -t-o �CtS"�`v\� c- oS ✓h am f vt W`. /► L-e tc GO%n.oCP . ru3- -rl.�` .tsi P S'trd, 2p 1 (n-r ieo�." f �/�`t Cot �-r �c�+��t(h itt= tr. '-to l�J LtCAe 3. tock.A. Page 1 of 2 9. PROPOSED USE IS: L�Residential ❑ Commercial ❑ Association ❑ Public 10. IF COMMERCIAL, IS THE FACILITY AND ITS ASSOCIATED LAND USES IN COMPLIANCE WITH APPLICABLE PROVISIONS OF STATE AND LOCAL LAWS, ORDINANCES, RULES AND REGULATIONS. 0 YES 0 NO, EXPLAIN = ' ' ' ' -"ING DATE: Silkw\s Z O PROPOSED COMPLETION DATE:Stnwtt�e,r; 2oo(-) -' '1 • s • ' 0 •F THIS ACTIVITY FOR WHICH A PERMIT IS SOUGHT NOW BEGUN OR COMPTFE I 0 Yes No (if yes, please explain) {{t 141221MMMM!RAI3Lq 1333 1h AlT31,171114niltftltFRONT PROPERTY OWNERS: Tax Parcel #: _ 3 - 2 t Tax Parcel#: - 3 ' 2- 3 -'nay. +- Name: NA. • S O Name: t Mailing Address: 3 �1 - Mailing Address: 2-C 3 rc tA) 14. CERTIFICATION: I hereby affirm that the information on this form and all attachments submitted herewith is true to the best of my knowledge and belief. As a condition to the issuance of a permit, the applicant accepts full legal responsibility for all damage, direct and indirect, or whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from the said project. _3 /0/2_0,77 Signature of applicant Date 15. AGENT AUTHORIZATION: (if applicant is not the owner of the property) I hereby authorize the above applicant to act on my behalf as my agent to obtain all necessary permits or approvals for the above project to be constructed on my property. N(ts\ Signature of owner Date 16. During the processing of this application Lake George Park Commission (LGPC) personnel may need to visit this site for the purpose of inspecting, measuring and/or photographing any existing docks, cribs, moorings, property lines, or other in-lake structures on the site. Please sign below to authorize LGPC members and/or staff to conduct such a site visit. 1,,,(zott. Signature of owner Date Do you wish to be contacted prior to the visit? X yes a no Comments THIS FORM MUST BE ACCOMPANIED BY SITE LOCATION MAP, PROJECT PLANS AND ANY OTHER REQUIRED INFORMATION (SEE APPLICATION INSTRUCTIONS). IF THIS IS AN ASSOCIATION LAKEFRONT OR IF OTHER PARTIES HAVE DEEDED OR CONTRACTUAL ACCESS TO THIS LAKEFRONT, PLEASE PROVIDE NAMES AND ADDRESSES OF ALL INVOLVED PARTIES. Page 1 of 2 t_• ��` �' / t Pe k)� / / 151 . / cf ir / ''' 111$1111"•. _ir. ..." ,i 1 / _c iff !" ' 1 V j 2 1 S%'''''.....11-•/-.''') /' ' I '1 • / \ : ni r . 'C Fir `�.� :.y '.�.. ) \ . • */ - ...iv • `\ ! - _ I.(3 1 .1)-A Di's. -1•;tc,t-7 . -, .-. . . ...., i'{; • N. f .• ECEIIEO 7 . f . • • t 1 i r r f ar LAKE GEOKPARK COMM /g 17 / . . .••• . il._._.__________,_-...-----' . 1 -1:1) ' . - -,1 ) 5�. , 3 - k�z zz � ' . I-- ___. 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