6601 BUILDING PERMIT
TOWN OF QUEENSBURY No 6601
WARREN COUNTY, NEW YORK
PER MISS N is hereby granted to Jillbrook Bread
lessee
XXVIslER of property located j...)
Quaker Road Street,Road or Ave.
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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 O
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
ed
1. OWNER'SAddressis Louise Silverthorne Fi
Bolton Landing, New York 12814
2. CONTRACTOR or BUILDER'S Name
Action Septic
3. CONTRACTOR or BUILDER'S Address
5 Spruce Court
Glens Falls, New York •o
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( I Masonry ( )Steel ( )
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7. PLANS and Specifications new seepage pit per application submitted.
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8. Proposed Use
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Sewage system for commerical building.
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rt.
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$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Jan. 1 19 81
(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 19th Day of September 19 80
.70
SIGNED BY /v�— � V C - for the Town of Queensbury
Building and Zoning Inspect°
TOWN OF QUEENSBUR,
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1 . 51
SEP i�oo J
TOWN of OTTEENSBURY
U 1 BUILDING AND ZONING DEPARTMEWVl.M. 5622- F-e
BAY AND HAVILAND ROADS, . #17 1 8 1 9 110111�12�1�2i5�6
GLENS FALLS, NEW YOPRTC 12801
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A SEWAGE
DISPOSAL SYSTEM WITHIN THE TOWN OF, OUEENSBURY
OCCUPANT'S NAME )111;11brooK }Sreo...ek ADDRESS Qua K2k /o G
TELEPHONE OWNER'S NAME /_ S; I U G k
ADDRESS r t o ,, j a„ d.,n g i Y / $/t NUMBER OF BEDROOMS
GARBAGE GRINDER? (YES OR NO) TOPOGRAPHY: FLAT, ROLLING, STEEP,
SLOPE, GENTLE NTLE SLOPE;, OTHER
NATURE OF SOIL: CLAY, SANDY, LOAM, GRAVEL, ROCKS, ETC..
PERCOLATION TEST WATER SUPPLY: MUNICIPAL, WELL, OTHER
•DIAGRAM OF PROPOSED SEPTIC SYSTEM
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OTHER PERTINENT INFORMATION
IT. IS HEREBY AGREED THAT IF THIS APPLICATION AND PLATS ARE APPROVED,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE N ACCORDANCE
WITH DETAILS SHOWN.
DATE SIGNATURE OF APPLICANT
(" nRGE PA?tK (:OAS[ISST l?V v -
pna ure
��� � �� (date)' •
PRP
OWN OF QUEENSBURY.
Building. Department
inapectos Report • Date I LS ird
Name /3i2ed '( f`; 12- 1)
Location .
. Permit No. J' - Weather t
(peo Remarks
Excafation j
Footing Forms
Footing & Piers
Foundation
Cenient Coat
Waterproofing
Backfill
Final Survey
Framinr
Sheathing _. •
-
F.:of Pelt
Roofing
Masonry Veneer
Rough Plhg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plha. Fi';tures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst. •
Septic Approval L/ I —
FCunCat.Lori
Insuiat.;.on_ Wails
"Ceiling-1
.�..�.. lam - �t
• / BInspector
REMARKS
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