1265 BUILDING PERMIT
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TOWN OF QUEENSBURY No. 1265
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WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Ha ells Lark I nL
Street, Road or Ave,
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OWNER of property located at __,it ■ G en a Rd
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in the Town of Queensbury, To Construct or place a _ Sewage plterat� on
at the above location in accordance to application together with plot plans and other information hereto flied arlci
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is
Rte 9 & Glen Lake Road
Lake George , New fork
z Richard Lee ILDERS Name
3.. CONTRACTOR or BUILDER'S Address
A. ARCHITECT'S Name
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g, ARCHITECT S Address No
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B_ TYPE of Construction — (please indicate by X)
{ } Wood 'Frame { ) Masonry { I Steel I } t
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7. PLANS and speciticatiorrs
No. 1000 Gal . Cane . Tank and two 8 XSt dry -wells , CL
S. Proposed Use
Sewage Alteration
$ _ E}[y _ PERMIT FEE PAID — THIS H1S PERMIT EXPIRES 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 Clueensbury before the expiration date)
Dated at the Town of Queensbury this
27 Clay of . ,] ri�
for the Town of Queensbury
SIGNED BY Building and ZonF Inspector
TOWN OF QUEENSQURY
WARREN GOUNTI NEW vORK
Application for
A PERMIT To CONSTRUCT , ALTER. OR ENLARGE A SEWAGE
DISPOSAL SYSTEM FOR A PRIVATE RE:.�1 DENC'E WITHIN THE
TOWN OF QUEEN.If
TOWN OF QUEENSIBURY
Mail or bring this application to ;
a [�11
Building & Zoning Department [R a� 1YP �f
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Queensbury Town office Building �Jc � 1 � � �
R,. D . 1 Bay Road
Glens Falls , New York 12801 p,M, P.M.
7} $ `91101I11121I ` 21314 ` 5k6
This application for a Sewage Disposal Permit Trust 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 rIIlU1V.BER
3 . Application is for :
New construction of private dwelling .
Alteration or enlargement of existing sewage oisposal system .
4 . Description of building :
a . number of bedrooms
b , garbage grinder
YES C7R NO
5 . Topography :
at , ro zn steep slope , gentle s ope , etc .
6 . a . Nature of soil . ( Describe to a depth of b feet if tile
field is to be used or 10 feet if leaching .: its are
proposed , giving thickness of ° us strata such as
top soil , clay , loam , sand , ravel rack , etc . )
b . How determined ?
7 . a . Soil percolation test made by r
( Refer to Part III Bulletin 1 , N . Y . S . Department or
ea th
,
b . Percolation test notes submitted ? H
YES C7 R NQ
Be proposed sewage disposal system indicated on attached plan or
sketch ? �. s, c�_ i • �C
YES OR NO �,! �s 4 CJ
9 . Date when construction will commence
It is hereby agreed that if thin apV lication And att :� ched
dated or, any amendment or revi n e,
i ,., the, roof ,
_
are approved ,inst� atzon . of sewage disposal facilities will be
made in accordance with the details thereof as shown on such
approved plans .
installed By : Contractor ignatu e of app scant
Owner