1659 ir
CERTIFICATE C3F OC+CUPAN"" '
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
f
Date , x, f. t T r7 _ is
This is to certify that work requested to be dune as shown by Permit No.
has 6ccn completed.
This structure may be occupied as a . � k[.�1 �► f�� ,'cV�13i�
Iovation tl ?"t! i"�d3lE ='oa
By Order Town Board
TOWN OF QUEENSSURY
Building Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY
No.
WARREN COUNTY, NEW YORK
00
PERMISSION is hereby granted to Tnrnch s R R Kama F P cimbard Sr- ■
tT'
OWNER of property located at Mil.:i^-Y i ndq 1 e Road Street, Road or Ave.
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in the Town of Queensbury, To Construct or place a Dwel l inQ Sewage Sys. em
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. F9
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t. OWNER'S Address is
R . D . #1 Box 296 A . !'
Lake George , New York
2. CONTRACTOR or BUI LDE R'S Name
Owner
3. CONTRACTOR or BUILDER'S Address
Owner
d. ARCHITECT'S Name
5. ARCHITECT'S Address
G- TYPE of Construction — (Please indicate by X)
:k 1 Wood Frame 1 I Masonry ( ) Steel 1 1
7, PLANS and Specifications
NO, 54tX281 as per plot plans and specifications ence sewage �
sys -ten h
8. Proposed Use ~
CL
One- Family Dwelling Sewage System two car attached garage i„
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rn
C/O 5000
$ q() . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES 19 72 0
(If a longer period is required an application for an extension must be rnede to the Building and Zoning inspector of the Q
town of Queensbiury before the axpiretion date.)
Dated at the Town of Queensbury this 10 Clay of April t9 72
SIGNED BY the Town of Queensbury
wilding arid Zoning Inspector