2799 •
BUILDING PERMIT
TOWN OF QUEENSBURY No 2799
WARREN COUNTY, NEW YORK
51)
PERMISSION is hereby granted to Henry Kahn
OWNER of property located at 6 Sherwood Drive Street, Road or Ave.
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.
1. OWNER'S Address is
Same.
2. CONTRACTOR or BUILDER'S Name
Stan Granger
3. CONTRACTOR or BUILDER'S Address
Boulevard, Glens Falls, N.Y.
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4. ARCHITECT'S Name
61
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5. ARCHITECT'S Address c+
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6. TYPE of Construction— (Please indicate by X) 0
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. As per application and didgram indicate. a.
8. Proposed Use
Sewage alteration.
$9 ,00 PERMIT FEE PAID —THIS PERMIT EXPIRES lle„cemberr 28.3 19 73
(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 28th Day of December, 19 73
SIGNED BY ` for the Town of Queensbury
Bu ing and Zoning Inspe'or )
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TOWN OF QUEENSB R.Y
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WARREN COUNTY, NEW '!ORK BLEUEilyis
QUt��P,l V3��`tApplication for ,L
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A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A SEWAEfE Pnn
DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE WITHIf, OMV;V.112'1J213�4�5�6
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:
2. Specific location of property:
(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:
fl , 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 thickn ss of v ' ous strata such as
top soil, clay, loam, san1) ravel , rock, etc. )
b. ' How determined? 90
7. a.` Soil percolation test made by v�
(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 att ched plan or
sketch? (YES O'NO) C>e4 W t ��1D
9.. Date when construction will commence
It is hereby agreed that if this application and attached plans
dated or any amendment or revision thereof,
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are approved, nsta113on of sewage disposal facilities will e
made in accordance with the details thereof as shown on such
approved plans.
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