09-15-1967 OFFICIAL. NOTICE
REPORT OF NEW CONSTRUCTION
(In cotnpliance with an Ordinance of the Town of Queensbury)
F Lao;
Mail or bring all three copies of this form Date................./.. �1
. TO.
M 4629
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 ANSIVER EACH OF THE FOLLOWING QUESTIONS
�
Owner of the land on which the proposed construction'is to be done.' F P
2.
tv, Location of the property. (by reference to street or highway)
3.
Intended use of the proposed building or addition.
4.
Indicate the approximate distance between such building;and the street or highway.
5. 6.
ti
Will a water tap be requested? Will a highway permit be requested?
� - 73Se-
Your telephone number Any other pertinent information
w �This Build ng Permit Signed
issued and approved:
(owner,or other authorizcd person)
Date ��// Address
a
Approved by: % ...... .c
Zoning & BuildingInspector.
If intended construction will require any excavation in a town highway right-of-way (such as a water main or
sewer connection) a permit must be secured from the Queensbury Highway Department, 2 Aviation Road
(Tel. RX 2-2979) PRIOR to such excavation.
If a water tap wili be requested, application should be made to the,Queensbury Water Department, R, D. 2.
Lake George Road, Glens Falls, N. Y. (Tel. RX 3-3500) at least 48 hours in advance to enable scheduling
of the work.
u�-9' 16