1140 BUILDING PERMIT
TOWN OF QUEENSBURY
No. S1140
WARREN COUNTY, NEW YORK "mod
court Motel
PERMISSION is hereby granted to Graycourt
OWNER of property located at Lake George Road (Route 9) Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage alteration - motel
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
Lake George Road-Rte. 9
Glens Falls , New York
2. CONTRACTOR or BUI LDER'S Name
3. CONTRACTOR or BUILDER'S Address -
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address !ZS
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( 1 0
7. PLANS and Specifications
Topography - rolling - Gravel
No.
8. Proposed Use
Sewage alteration - motel
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$ 5.00 PERMIT FEE PAID—THIS PERMIT EXPIRES 5-1-19 71
(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 23rd Day of April 19 71 ts7
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SIGNED BY for the Town of Queensbury
Building ap oning Inspector
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SEWAGE DISPOSAL APPLICATION
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A
SEWAGE DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE W FTHII1 e VR�uRv
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1. Name and mailing address of applicant: APB? 2 3 1971
G • -L, -Z/ A.M. P.M.
: . R ,(T �� Im'10I11I12I112moi6
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2. Specific location of property: ( 7-zi 71 hApi��
3. 'Application is for: SW0-1/4
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New construction of p� �•
Alteration or enlargement of existing sewage isposal system.
4. Description of building:
a. number of bedrooms
b. garbage grinder
(yes or no)
5. Property line dimensions, or total area of property:
6. Topography: `I`
(flat, roll ng, steep slope, gentle slope, etc. )
7. 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. )
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b. How determined? Z y .r—-
8. a. Soil percolation test made by ---
(Refer to Part III, Bulletin 1, N. Y. S. Department of Health)
b.. Percolation test notes submitted?
(yes or no)
9. Proposed sewage disposal system indicated on attached plan or
sketch?
(yes or no)
10. Date when construction will commence
It is hereby agreed that if this application and attached plans ..
dated or any amendment or revision thereof,
are approved, installation of sewage disposal facilities will be
made in accordance with the details thereof as shown on such
approved plans.
(Dated) ! Signat e of applic 'it
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