6608 • BUILDING." PERMIT
TOWN OF QUEENSBURY No. 6608
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to • Robert Sirkus
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OWNER of property located at 15 Orchard Drive Street,Road or Ave. rt
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in the Town of Queensbury,To Construct or place a Sewage Alteration • 1-3-
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'SAddressis 15 Orchard Drive
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Action Septic H
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3. CONTRACTOR or BUILDER'S Address • Fi
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, 5 Spruce Court
Glens Falls, New. York a
4. ARCHITECT'S Name d
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5. ARCHITECT'S Address
- •6. TYPE of Construction.—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications N
160' tile and dist. box
No. LC)
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8. Proposed Use Y
Sewage alteration to dwelling o
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$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Jan. 1 19 R 1
(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 7 2nd Day of SPpi-PmhPr 19 R 0
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SIGNED BY -�- 6 for the Town of Queensbury
Building and Zoning Inspector
TOWN OF ,1:11VEISBOR..t TOWN OF QuEgri\jsr7;u ,
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ears:. PERTINENT T.P./701ZWIMe N 7.T :LS HERE 1-2,Y; 7},G1"-Z, ED THAT IF :s APP:C.I.XCP.F.ZON AND `P OTTS 12071.F.
YON or SEWAGE D 7:SPO SEL FACI T..,IT I IF:3, WILL BE 12 C.01-'1.
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