09-11-1967 OFFICIAL NOTICE
REPORT OF NEW CONSTRUCTION
�-- (In compliance with an Ordinance of the Town of Queensbury)
Mail or bring all three copies of this form Date.... i..�...................•
TO:
JOHN O. WEBSTER, SUPERYISOR a ��s
0� ,41AVi'q'q N° 3409
Glens Falls., New York
The undersigned hereby states that he intends to construct a building or structure,
or an addition to an existing building or structure, on land in the Town of Queens-
bury, as per the following information:
PLEASE ANSWER EACH OF THE FOLLOWING QUESTIONS
Owner of the land on which the proposed construction is to be done.
2.
Location of the property. (by reference to street�high,,y
3 eo,,i
`�dLP. loo.
Intended use of the propose building or addition.
4. .,
r a o #- //� ' 4z,4—.
Indicate the approximate distance between such building and the nearest Town highway.
5.
State whether or not you intend to apply to the Town Board for any change in location of any highway, or
for the extension of existing water mains, if any, or for any other Town facility.
An other pertinent information.
Y
$kp lIl Signed _ .. ................................_...................................._._........_.._.._.........._.... ...h....................p......s............................
O � N� bd@ ��,cV'' er,q�other a/u-t;hor�iz(e`d�pers�)
11 e��s� tIO�00hs Address ......... ....... .........._...... ...._........._.......... _._...(_..�....J..' ._�.�._._v`'1..` _......�........... ..............
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hj� illy .
Le se h This Buildi Permit Issued and Approved by:
`- x�,29�96.'�'art��eQ' " Zoning & Building Inspector
Date : 10/2/1967