1752 BUILDING PERMIT
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TOWN OF QUEENSBURY cu
No. 1752
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to C'ha s pal dwi
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OWNER of property located at West Mountain Road Street, Road-or Ave.
in the Town of Queensbury,To Construct or place a SPwagP System
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
West Mountain Road
Glens Falls, New York
1 9f3(11
2. CONTRACTOR or BUILDER'S Name
Jay Sweet
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications •
No. 100' tile field `t
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8. Proposed Use
Sewage System
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$ 5.00 PERMIT FEE PAID —THIS PERMIT EXPIRES 6-1— 1972 arm
(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 9 Day of May 19 72
SIGNED BY for the Town of Queensbury
Building an Zoning Inspector �� )
TOWN. OF Q E NSBUR,Y
WARREN COUNTY, NEW •fOF:K
Application for
TOWN OF QUE sNL E3U .?
A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A SEWA
DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE WITHIN HE rap - A
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TOWN OF QUEENSBURY MMY 8 19(L
Mail or bring this application to : A.M. g�10�11�12I1I2I3I4�6.M.
Building & Zoning Department 1. I ,�' °
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:
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Lei/
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:
(flat, 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 thickness of various strata such as
top soil, clay, loam, sand, gravel, rock, etc. )
b. How determined? e5 T-_
7. a. Soil percolation test made by
(Refer to Part III , Bulletin 1 , N.Y.S. Department of Health)
b. Percolation test notes sub itted? ES OR NO)
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8. Proposed sewage disposal system indicated on attached plan or
sketch?
(YES OR NO)
9. Date when construction will commence
It is hereby agreed that if this application and attached p1nsof,
dated or any amendment or revisinf
ther
are approved, hst� a1lation of sewage disposal facilities will be
made in accordance with the details thereof as shown on such
approved plans.
at e of appliee:
Installed By: Contractor m ign
Owner