1890 BUILDING PERMIT
TOWN OF QUEENSBURY No 1890
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Country Club Glens Falls
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OWNER of property located at Round Pond Roa d. Street, Road or Ave. Z
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in the Town of Queensbury,To•Construct or place a Sewage 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. cn
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1. OWNER'S Address is C7
Round Pond Road
Glens Falls, New York
12801
2. CONTRACTOR or BUILDER'S Name
J. Sweet
3. CONTRACTOR or BUILDER'S Address
Queensbury Sewer Service
Bay Road
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( I Steel ( )
7. PLANS and Specifications
0
No. as per plot plans submitted
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8. Proposed Use 'U
Sewage System Alteration t7
0
$ 5.00 PERMIT FEE PAID —THIS PERMIT EXPIRES 8-1- 19 79
(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 3 Day of J111 y 19 72
SIGNED BY /eg for the Town of Queensbury
Building and Zoning Inspector � � •t/�
TOWN OF QUEENSBURY
WARREN COUNTY, NEW 'f'ORK TOWN OF QUEENSBURY
Application for iCIEDVE .fig-42N
3 0 1972
411
A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A 6EWAA,ii; M.
DISPOSAL SYSTEM. FOR A PRIVATE RESIDENCE WITHIN? 8j 1 11m1l213I401B
TOWN OF QUEENSBURY '
Mail or bring this application to :
Building & Zoning Department
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:• C
•
2cL _61.
o j) .
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: 1041-
TT at, 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 G C
top soil, clay, loam, sand, 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? (YES OR NO)
8. Proposed sewage disposal system indicated on attached plan or
sketch?
( E ;R NO)
9.. Date when construction will commence _/i!_ ,Z�It is hereby agreed that if this application and attached plans
dated or any amendment or revision thereof
are approved, installation
details thereof as shown on
eal ftssuchl be
made in accordance with
approved plans.
9 Censta led By:rCpntractor o • (S 4T at :•e o applicant;)
Owner
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