5659 BUILDING PERMIT
TOWN OF QUEENSBURY 5659
No.
WARREN COUNTY, NEW YORK
PERMISSION is ereby granted to Karen Melega
8 Westmoa.,Ave.
OWNER of property located at 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 8 Westmoor Ave.
Glens Falls, N. Y.
2. CONTRACTOR or BUILDER'S Name
Action Septic
3. CONTRACTOR or BUILDER'S Address s
fD
5 Spruce Court
Glens Falls, N. Y. 5
o .
4. ARCHITECT'S Name 0
Fi
J
m
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Dry well and #3 stone per application submitted.
No.
CD
8.'Proposed Use
(D
Sewage system for dwelling
rl
m
Fj
$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 1 1979 r�r
N-
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the p
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 3 0 th Day of January 19 79
SIGNED BY � P- @ for the Town of Queensbury
Building and Zoning Inspector
OF QUEENsBUE:Y
REGEOVE
TOWN OF QUEENSBURY !A N 3 0 11/9
. BUILDING & ZONING DE;a AMMEN`I'
BAY & HAVILAND ROADS R§1 A.M. S Q0 F 1.
GLENS FALLS, NEW YORE' 12 801 7 U319 I10I192I 1 P.0 r 1519
A
APPLICATION FON. A PERMIT TO CONSTRUCT, ALTER OR E.1.''fLi3R(1E pp,,
A SEWAGE DISPOSAL TI M WITriIN THE TOWN OF OfE2NS1 URiY I�J'� / /kte irL,
003UPANT'S NAME ay...CH ADDPFeq 17h44011,2ent_
TELEPHONE OWNER' S NAME
ADDRESS NUMBER OF BEDROOMS
GARBAGE GRINDER? (YES OR NO) TOPOGRAPHY e FLAT, ROLLING, STEEP, SLOPE,
GENTLE SLOPE, OTHER
NATURE OF SOIL: CLAY, SANDY, LOAM, GIAAVEL, ROCI 3 ETC.
PERCOLATION TEST WATER SUPPLY: MUNICIPAL, WELL, OTHER
DIAGRAM OF PROPOSED SEPTIC SYSTEM
7-?(:5-1,)
IJ
)2Zici/
.
OTHER PERTINENT INFORMATIONS �.. 2.D77 f J�
IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVED, .
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE TN ACCORDANCE
WITH DETAILS SHOWN
DATE t - _I S I GNATU1E OF APPLICANT
LAKE GEORGE PARK COMMISSION APPROVAL:
(Signature)
r /e ,' ikkere,
Ric" '