1152 BUILDING PERMIT
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TOWN OF QUEENSBURY CON)No. S 1152
��"" ,r�, WARREN COUNTY, NEW YORK �
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PERMfSSION is hereby granted to Richardson ' s Store (H . S . & Leon Richmdson)
Cn
Main Street - W . G . F .
OWNER of property located at Street, Road or Ave-
in alteration p
in the Town of Queensbury, To Construct or place a g
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_
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1 . OWNER'S Address is
43 Main Street
West Glens Falls , N . Y . o
2_ CONTRACTOR or BUILDERS Name po
Pao
Chris Drellos - Sanitary Sewer Service =.
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3. CONTRACTOR or BUILDERS Address
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51 4th Street �,
New York
4. ARCHITECT`S Name
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5. ARCHITECTS Address
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fi. TYPE of Construction — (Please irxticexe by X)
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( } Woad Frame ( ] Masonry ( ] Steel ( )
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7. PLANS and Specifications alteration of existing sewage disposal System No. 2 &= bedrooms -Topography- flat -Sail - sand-
excavated
S. Proposed Use
Sewage alteration system
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$ 5 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES 5 - 1 - 71 19 �
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 'rR
town of Oueensbury before the expiration date.) W
Dated at the Town of Queensbury this 2 7 th Day of April 19 71 �
Y � �
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SIGNED BY for the Town of Queensbury )-'-
Build' and Zoning Inspector O
TOWN OF QUEEMSBURY
WARREN COUNYY, NEW YORK
Application for
A PERMIT TO CONSTRUCT , ALTER. OR ENLARGE A SEWAGE
DISPOSAL SYSTEM FOR A PRIVATE REM LrENCE WITHIN THE
TOWN OF QUEENSBURY
Mail or bring this application to : ��vVN Building & Zoning Department QUEeNSF3URy
b R . D . 1 Say Town Office Building p
R . D . 1 Bay Road
Glens Falls , New York 12801lyl1
ArR
This application for a Sewage Disposal Permit must b MV P.M.
accompanied
9 �1 lI I� 12 3 4 6
by a plot plan drawn reasonably to scale . ' � . + . � . . � . � , . � . � , � , � K
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 :
f a'`
A, a , Al S G U:• c '
2 . Specific location of property : C° x- z. •-
STREET AND NUMBER
3 . Application is for :
New construction of private dwelling .
Alteration or enlargement of existing sewage disposal system .
4 . Description of building3
a . number of bedrooms 2
b . garbage grinder
YES OR Na
5 . Topography : -}
kflat, rolling , steep slope , gentle dope , etc .
6 . a . Nature of soil . ( Describe to a depth of 5 feet if the
field is to be used or 10 feet if leaching pits are
proposed , giving thickness of various strata such as
top soil , clay , loam , sA d� gravel , rock , etc . )
b , How determined ?
7 . a . Soil percolation test made by
( Refer to Part III , Bulletin 1 , N . Y . S . Department of Health )
b . Percolation test notes submitted ? "`------- "ft-1.j
8 . Proposed sewage disposal system indicated on attached plan or
sketch?
YES OR NO
9 . Date when construction will commence� 3
It is hereby agreed that if this apt lication and attached
dated �� � - - or any amendment or rev 3r3 ; thr. reo ` ,
are approved , inssta 1ation of sewage disposal facilities will be
made in accordance with the details thereof as shown on such
approved plans .
nstal �le y ; Contractor - �::: ignature of applicant )
Owner