1442 BUILDING PERMIT
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TOWN OF QUEENSBURY No. 1442
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Rey Foley
OWNER of property located at 19 Lupine Lane 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. OWNE R'S Address is
19 Lupine Lane
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
W.W. Maille
3. CONTRACTOR or BUILDER'S Address
West Mt. Road
R. D. #1, Glens Falls, New York
4. ARCHITECT'S Name
Same
5. ARCHITECT'S Address
Same
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) -
7. PLANS and Specifications
No. as perapplication submitted. ro.
8. Proposed Use
r
Sewage System cn
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$ 5.00 PERMIT FEE PAID —THIS PERMIT EXPIRES 12-1— 19 71
(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 24 Day of September 19 71
SIGNED BY Vi;2r �J. fo the Town of Queensbury
-- Building and Zoning Inspect /0iL )
SEWAGE DISPOSAL APPLICATION
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTEr{ OR ENLARGE A
SEWAGE DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE WITHIN THE
LAKE GEDRGE PARK § TOWN OFTWE8 ;:;B ENSC31..it Y
IIEGEIIVED
1. Name and mailing address of applicant: u �J Li= z 1971
71WI-OM12'1V12,1109.
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2. Specific locatio of property:
3. Application is for:
New construction of private dwelling.
Alteration or enlargement of existing sewage disposal system.
L . Description of building:
a. number of bedrooms `3
b. garbage grinder
(yes or no)
5. Property line dimensions, or total area of property:
/ --Ic a
6. Topography: -'��-
(flat, rolling, st ep slope, gentle slope, etc. )
7. a. Nature of soil. (Describe to a depth of 5 feet if tile
i field is -to- be used- or 10 feet if leaching -pits --are -- - -- - —
proposed, giving thickness of various strata such as
top soil, clay, loam, sand, gravel, rock, etc. )
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b. How determined?
8. 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)
9. Proposed sewage disposal system indicated on attached plan or
sketch?
(yes or no)
10. Date when construction will commence 9 a %/
It is hereby agreed that if this application and attached plans
dated or any amendment or revision thereof,
are approved, installation of sewage disposal facilities will be
made in accordance with the details thereof as shown on such
approved plans.
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(Dated) (Signature of applicant)..
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