1721 BUILDING PERMIT
TOWN OF QUEENSBURY c
No. 1721
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to James Fogarty
OWNER of property located at 20 Clark Street Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage System
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
20 Clark Street
Glens Falls, New York
12801
2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( ) Wood Frame ( I Masonry ( )Steel ( )
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7. PLANS and Specifications
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No. m
as per plot plans submitted. En
8. Proposed Use
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Sewage System (Alteration)
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$ 5.00 PERMIT FEE PAID —THIS PERMIT EXPIRES 5.)-1— 19 72
(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 28 Day of April 19 72
SIGNED BY for the Town of Queensbury
wilding and Zoning Inspector ryj 40j
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TOWN OFQUEENSBURY
WARREN COUNTY, NEW '?ORK •
TOWN Or QUUEENSZLIRY
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Applieatoo� foi
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A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A SEWAGE APR 2 8 19i
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DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE WITHIN TH5A P.M.
TOWN OF QUEENSBURY ?O I9oI �=1�1�2'1i2�3�4�5.
Mail or bring this application to : "A
Building & Zoning Department
Queensbury Town Office Building
R.D. 1 Bay Road
Glens Falls, New York 12801
This application for a Sewage Disposal Permit must be
accompanied by a plot plan drawn reasonably to scale
showing all dimensions , the size of the lot, the location
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on the lot of the water supply and sewage system.
1. Name and mailing address of applicant:
(Yee-a- ii. ,,<(//6, ,.. e_e• .----- ,./i/ /p--.o /
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2. Specific location of property: C ,7 di r/l S'r.
( STREET AND NUMBER)
3. Application is for: •
New construction of private dwelling . •
Alteration or enlargement of existing sewage disposal system.
4. Description of building:
a . number of bedrooms .
b. garbage grinder
(YES OR NO)
5. Topography: 17 /
(flat, rolling , steep slope, gentle slope , etc. )
6. a. Nature of soil. (Describe to a depth of 5 feet if tile
field is to be used or 10 feet if leaching pits are
proposed, giving thickness of various strata such a ,
top soil, clay, loam, sand, gravel, rock, etc. )
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b. How determined?
7. a. Soil percolation test made by
' (Refer to Part III , Bulletin 1 , N.Y.S. Department o Hea th
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b. Percolation test notes submitted? (YES OR NO)
8. Proposed sews e disposal system indicated on attached plan or
sketch? �'
- — -- .- ES OR-NO)- --- - - — ---
9. Date when construction will commence
__.. e.,;" , ---4. /-- -7__... - -Zi-.4 • ----
It is hereby agreed that if this application and attached p►lansof,
dated , ,'-J( Z or any amendment or revision
are appr, ed, nstallation of sewage tdisposal lsfacilithownoessuill be
made in accordance with the details
approved plans. •
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' AP .e..- e_. '.410x0 7./ ti- a'r- ' .
nsta led By: ontractor
S gnature of -a • ican J
Owner
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