6133 BUILDING PERMIT
TOWN OF QUEENSBURY No. 6133
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Frank A. Roberts
•
OWNER of property located at Haviland Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage alteration
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 R. D. #1
Glens Falls, N. Y.
2. CONTRACTOR or BUILDER'S Name
Robert Ellsworth113.
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3. CONTRACTOR or BUILDER'S Address rt
R. D. #1
Lake George, N, Y.
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( ) F,d
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7. PLANS and Specifications
1000 gallon concrete tank and 250
No. tile field per application submitted.
8. Proposed Use
Sewage system for dwelling U,
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5. 00 Feb. 1 1980 m
$ PERMIT FEE PAID —THIS PERMIT EXPIRES �
(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.)
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Dated at the Town of Queensbury this llth Day of October 19 79 `Pi
SIGNED BYL for the Town of Queensbury
Building and Zoning Inspector -
TOWN OF QUEENSE,,,N ,
TOWN OF QUEENSBURY
CGfOVE
BUILDING AND ZONING DEPARTMEN OCT 1 U 1979
BAY AND HAVILAND ROADS, R. D. 1 $60 e e��
GLENS PALLS, NEW YORK 12801 i 8)9 i10)1112)1 2 3 4 5)6'
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE
A SEWAGE DISPOSAL SYSTEM WITHIN THE TOWN OF OUEENSBURY
OCCUPANT'S NAME F2Irk /4 - k,0,,4�(S ADDRESS 7-4f" �`�c� rC r5/
TELEPHONE 9 CGC 7 OWNER'S NAME <<
ADDRESS -s-~25 NUMBER OF BEDROOMS —S
GARBAGE GRINDER? 4/0 (YES OR NO) TOPOGRAPHY: FLAT, ROLLING, STEEP, SLOPE ,
OTHER
NATURE OF SOIL: CLAY, SANDY, LOAM, GRAVEL, ROCKS, ETC
PERCOLATION TEST • VATEP SUPPLY: MUNICIPAL, V7 LL, OTHER
DIAGRAM OF PROPOSED SEPTIC 6YSTEM
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OTHER PERTINENT INFORMATION /0 -"I �`Ql`417 (! 4 .
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IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVED,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL PE MP.DP IN ACCORDANCE
WITH DETAILS SHOWN.
DATE /°�/0C
� 9 SIGNATURE OF �PPL�CA.raT
LAKE GEOR.GE PARK COMMISSION APPROVAL:
(signature
I-5ai
(date)
- TOWN OF U•EENSBURY
Builds ig. Department
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Inspects Report Date //>/7 79
Name ei ct J,,
• Location F ��GdLJc%i.�
. Permit No. (/ 33 • Weather
Remarks
Excavation I
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing •
Roof Felt
Roofing 4
Masonry Veneer
Rough Plhg. it
Relief Valves
Wail Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval I
lOOrS
FCunda ticm
Insulation Walls
—Ceiling
BuiidinInspector
REMARKS