6460 BUILDING PERMIT
TOWN OF QUEENSBURY No. 6460
r j n WARREN COUNTY, NEW YORK•
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PERMISSION is hereby granted to 9wi n T,_ All Pn
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OWNER of property located 41 LI-3 West Mountain Road Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration
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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 R. D. #2
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Carl Dingman
Reliable Sewer Service
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3. CONTRACTOR or BUILDER'S Address cr.
R. D. #3
Glens Falls, New York
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4. ARCHITECT'S Name fv
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5. ARCHITECT'S Address p,
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications CI)
1000 gallon septic, dist. box and 150' tile per
No. application submitted
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8. Proposed Usert-
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Sewage system for dwelling
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$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Nov. 1 19 80
(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 15th Day of July 19 8 0
SIGNED BY V- w for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEENSBU m .
TOVV OF 00ErNSBURY ECEIIVED
BUILDING AND ZONING DFPPRTMENT 1111
BAY AND HAVILAND ROADS, R D. li JUL 1 51980 jet i
GLENS FALLS, NEW YORK 12 M
801 --. r_-:,2
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APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE
A SEWAGE DISPOSAL SYSTEM WITHIN THE TOWN OF OUEFFSBURY e o. F___
OCCUPANT'S NAmr ex...t,..4 (7(1e1, 2,-=-N._ ADDRESS 1/11reSr.9'11— RsY
TELEPHONE OWNER 'S NAME
ADDRESS ' NUMBER OF PEDROOMS
GARBAGE GRINDER? (YES OR NO) TOPOGRAPHY. FLAT, PoLLINn, STEEP, SLOPE,
GENTLE SLOPE, OTHER _
NATURE OF SOIL: CLAY, SANDY, LOAM<ffiTIiii;)ROCKS, FTC.
PERCOLATION TEST WATER SUPPLY: MUNICIPAL, WELL, OTHER
DIAGRAM OF PROPOSED SEPTIC SYSTEM
(f:7'
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OTHER PERTINENT INFORMATION /0 0(9- 3 a //.091 ra-n /i
4) 5 r. 4 c) c ii-vd /5-0 ' Tile-
IT IS HERFEY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROWD,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN ACCOMANC?,
WITH DETAILS SHOWN. . N
DATE7.25- ' (9 SIGNATURE OF APPLICAIf::344J2
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LAKE GEORGE PARK COMMISSION APPROVAL:
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TOWN OF• UEENSBURY •
Building. Department
inspectors Report Date •7/,.S`�o�O
Name ti ,7
Location Lt 3< ��14
'. Permit No. (p(f '6 Q Weather
Remarks
Excat>ation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors ' •
Insulation Foundation
Walls
Ceiling
Buildinginspector
REMARKS •