1855 BUILDING PERMIT
TOWN OF +QUEENSBURY
No. , SIM
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to blaiiiiiiiiizd mahnsamV a .r
OWNER of property lace Street, Road or Awe,
i
40
in the Town of Queensbu p Queensbury. To Construct or laps a
at the above location in accordance to application together w plot plans and other information hereto tiled and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
a�F
i. OWNER'S Address is . •
AVIatlAw Re"
G1410110 FAIxS* nowyawk. ill�aa
N
2. CONTRACTOR or BUILDER'S Name
a CONTRACTOR or SUILLpDER S Address
267 WMV 06 Sty
4. ARCHtTECT'S Name
6, ARCHITECT'S Address �
•
•
S. TYPE of Construction — IPkase indicate by XI •
l wood Frame I I Masonry I I Steel ( }
T. PLANS and Specifications
a # .� .f ,. ,!
No. � ? w� * field +mast fty
8. Proposed Use
$ ww PERMIT FEE PAID — THIS PERMIT EXPIRES
(If a longer period is required an appiioation for an extansian 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 Day of 1972
SIGNED BY * for the Town of Queensbury
jV eulldirdWind Zo nspector
TOWN OF QUEENSBI.a RY T0VVM OF QUEENSMURY
WARREN COUNTY, NEW -' 01;: K IE
Application for F=e 0 0 V 'S�u
J U N 141972
A PEWIT TO CONSTRUCT , ALTER OR ENLARGE A :� L'kt4AC iM* 9 1 1112 1 2 3 41516
DISPOSAL SYSTEM. FOR A PRIVATE RE:.� I DENG:E Va T i it t3 '�� . � .��� • � • � , y • � • '
TOWN OF QUEEN6BURY
mail or bring this application to :
Building 8 Zoning Department
Gueensbury Town office Building
R . D . 1 Bay Road
Glens Falls , New York 12801
This application for a Sewage Disposal Permit rust fF
accompanied by a plot plan drawn reasonably to scale
slowing all dimensions , the size of the sewn eo ,system .
on the lot of the water supply g
1 . :'Name and mailing address of applicant :
73� ���
2 , Specific location of property : STREET tA-"a +
3 . Application is for :
New construction of private dwelling .
Alteration or enlargement of existing sewage isposal system .
40 Description of building :
a . s
be garbage grinder
b . Topography : ro Ing , steep slope , gentle s ope , etc .
. � . !Nature of soil . ( Describe to a depth of 9 feet es if tile
field is to be used , or IG feet if leachin
proposed , diving thckness of various strata such as
top soil , clay , loam , sand , grave ] , rock , etc . )
be How determined ?
7 , a . Soil percolation test made
iby iN—�-"� � °_ De Fartment o � iea th
( Refer to Part III ,
be Percolation test notes submitted ? _ -77E OR :No
$ , Proposed sewage dis oral system indicated on attached plan or
sketch ? E
9 . Date when construction will corn Hence — 6P
It is hereby agreed that if this, aP licatxof' an(-) a � -+ ched Ian4
dated _. -_ _ --
or any amend ^r nt or rPvi s, inc: tl^. rr. er, f ,
are approved , instal �ton of sewage disposal facilities will be
made 3n accordance with the details thereof as shown on such
approved plans .
aig t e of ape ' cant
lnsta ed By : Contractor