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1987-941 S CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY G WARREN COUNTY, NEW YORK November 1 88 Date 19 1 - This is to certifythat work 8 7- 9 41 requested to be done as shown by Permit No. I { has been completed. This structure may be occupied as a of Two Family ]welling i location 27 Margaret Drive -- [queen Victoria ' s Grant i Owner Guyer Builders , Inc . f I By Carder 'Town Board PrOWN OF QUEENSSURY i i Building & Zoning Inspector BUILDING PERMIT � TOWN OF QUEENSBURY nn No. $7-941 nn WARREN COUNTY, NEW YOR K C> PERMISSION is hereby granted to Queen Victoria ' s Grant Y OWNER of property located at 27 Margaret Drive Street, Road or Ave. in the Town of Queensbury, To Construct or place a I of Two Family Dwelling 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_ t . OWNER'S Address is Guyer Builders Inc . .� ro 119 Dunning St . ro Ballston Spa , N . Y . 12020 W ih 2. CONTRACTOR or BUILDER 'S Name rT l7 Same ' t Iw m ua 3. CONTRACTOR or BUILDER'S Address n ri Same {" rt 4. ARCHITECT`S Name 5. ARCHITECT'S Address rY Qr7 6. TYPE of Construction — {Please indicate by X3 r�u rr Oc:4 Wood Frame I ) Masonry ( 1 Steel I I W C 7. PLANS and Specifications n' No. 30 ' x 30 ' as per plot plan, specifications and application including septic system and attached one car garage . MODEL C S. Proposed Use OF TWO FAMILY DWELLING 0 r-n H Uo 75 . 00 July 1 88 $ 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 H+ town of Queensbury before the expiration date.) `4 Dated at the Town of Queensbury this 31st r� Day of December 19 87 SIGNED BY C, Q x '16-a� for the Town of Queensbury Building and Zoning Inspector ... '6LJ i'SJS G.'{.�6RL' la`+'i"LLB O O.L4w7• ar�' a ■ r - j II Application. No , f wre o/ Q"Wensburr Permit Issued 19 } '4 BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Havlland Road, R.D. 1 Box 88 Zoning Designations (;T �++ Oueenabury, New York 12801 Variance No, liCir. Site Plan Review No , LP Approved hY a r _5 e42 APPLICATION FOR BUILDING AND ZONING PERMIT e e r w * M w * * a e * a 0 * * 0 * :?�► A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING, The undersigned hereby applies for a Building Permit to do the following work which will be done in accordance with the description, plans and specifications submitted, and such special conditions as may be indicated on the Permit . The owner of this property is : Guyer Builders Inc -- P. O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518) 899-9161 property Location * 27 Margaret Drive Tax Map No 121 /a � 2 Street number or building lot number subdivision ruum (if applicable) Queen Victoria ' s Grant THE FERSOM RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING 'CODES IS . Richard H. Guyer III ( 518) 899-9161 Mass P. O. Address Tel . No . Name of builder Guyer Builders , InC tAddress 119 Dunning Street Tel . ( 518) 899-9161 Name of plumber rs , c .Addresa Street .Tel . Name of mason yen BUT.Laers , nC .Address g nee Tel . 0 . NATURE OF PROPOSED WORK : * ZONING INFORMATICN : X QQn*truction of a new building R A PLOT PLAN MUST BE PREPARED AND SUBMITTED, Addition to a building * drawn reasonably to scale and attached hereto , Altoration to a building * showing clearly and distinctly all buildings , (no change to exterior dimensions) * whether existing or proposed and indicate all Other work (describe) * set-back dimensions from property lines . Give * street and number or lot number and indicate FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot . Show location * of water supply and location and configuration LOCATION or STRUCTURES AFFECTED. of septic disposal area . * * COMPLETE INFORMATION REQUIRED Pam . sTe* size of property 100t pan ft x 120 ft . * Existing buildings) size NjA ft X' �ft . Model w PROPOSED BUILDING AND USE : of ^- * Existing buildings ) Use NIA Size of new struc a 3�,?____ ft X.„�ft dk Foundation-pier slab crawl/partial/full * Proposed building`, disc ce rom property line * see plot pfan on 2 * Front yard 30+ ft Rear yard 30+ ft . No . of stories (habitablespace) Side yards Hai ht (grade to ridge) 2,2 ' -- 6" ft . * ft and 15t ft If esidential, no , of families of 2 * If on corner , setback from side street ft No, Og rooms (excluding baths ) — OCCUPANCY INFORMATION Noe of bedrooms �2 * PRIMARY BUILDING NO& of bathrooms 2 One family dwelling t Primary heating system e e ectric* = family dwelling e �r Type of fuel ' Electricity * Multiple dwelling / 'Number of units 1k Noe of fireplaces to be installed * Permanent occupancy 3 Will a wood stove be installed? No Transient occupancy csntra� Air conditioning? No � Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial Ranch contemporary Lo cabin * Other Raised ranch Mansion Du le * if addition, what will use be? Split level Old style Bungalow * < Cape Cod Cottage Other * ACCESSORY BUILDING- Colonial Row Town House Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) * _Attached garage/one car/ two car! one car w * * s • r +e * * s • w * * * Private Storage building "ESTIMATED MARKET VALUE OF Jo * 'Other CONGTRUCTIODI INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED! Form SPA 4/8+6 md-vl WILDING PERMIT APPLICATION CONTINUED - WILDING SPECIFICATIONS * Types of construction, wood frame, fire safe, etc . `" pod frame Will any second-hand or ungraded lumber be used? If so , for what ? no ,Foundation wall material concrete block Thickness 8" Depth of foundation below grade (to bottom of footing ) 4 m3-ranum. ' Will there be a cellar? .no Heated or unheated? Floor sqo footage ft Will there be a basement? no Will any portion be used as living space? ( If so, what por sq. ft . - - Type of use? Type of roof - sloped shed/other Material of roof 1 r ass shingles onowwwwwoft Size, wood studs "X 6 spacing..2A."o . c . length 8 ft. exterior walls Joiets ( floor beams) 1st . floor NIA -+tX " spacing "o . c . spanN A ft . Foists ( floor beams ) 2nd . floor `2 ]f""l-c —" s acing��"o . c , span �ft. Overlays (ceiling beams ) 2 "X " spacing M " n.o . c . spa 14 fto Hoof rafters 2 "X 10 " spacing�Z4 o . c . spa,,n �I4 ft . Roof trusses (pre-engineered) spacing- n "o . c . span N/A ft. Exterior wall finish stained Of what material? 5 /$" x 4 ' x $ " texture Interior wall finish pain s rock If a garage is to be attachedo describe materials to be used for FIRE SEPARATION : 1/2" type "X" sheetrock I+s there to be an opening between garage 4-And dwelling? yes If so will a Fire-rated door, enclosure, and self-closing device be provided? yes Will a flue-lined chimney be installed? No Height above roof N/A ft . Depth of chimney foundation below grade N A ft: ' Depth of fireplace hearth PIA ft . in . Water supply - Municipal or private well uRuLicipal SEPTIC SYSTEM Distance from ANY private well ( including adjoining properties €t . (A separate application is necessary . for an re air or new installation of septic system) See S . P. E . D. S . permit # 026252� Town of Queensbury County of Warren e A F F I D A V I T STATE OF NEW Yo i I swear that to the best of my knowledge and belief the statements contained in this oppli.cation , together with the plans and specifications submitted , are a true and coa►plgte statement of all proposed work to be done ,on the described premises and that all provisions of the BUILDING CODE , THE ZONING ORDINANCE , and all other laws ,pertaining to the proposed work shall be complied with, whether spepified or not, and that such work is authorized ?py the 'owner . SWi7�RW TO D=PORE HE THIS Signature Z __ ; ee Mm er , ownfr4s agent , arcrKiect , con ra 15—r day of A-t�t y 19 V I PA UL/� u, Notary Public, State of IVLVr , u Qualified No Chi 4864727 anectady Gour+ty . VptAwy Public , Warren County. N. Y . COIAIiii#sinn Expires July 7 19V M � ..i... ik tM eF 1t A 1k ! • * • * * • * * * * a1r * * * �► * yr f 74 f ♦ # * 1k * R yt t i t i tk * ri � # SPE4� COKPITIONS OF THE PERMIT : 775 Square fact livuv 264 square foot garage - one stall 4 1239 @ $7 .0011()O"or part of 5 . 00 am stall garage $5 .00 CI© perIait #. Total TOWN OF QUEENSBURY ItC44 WARREN COUNTY , NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . ANSWER ALL of the following : 10 Gross floor area 975 S . F . 2 . Type of heat Raseboard electric 3 . Is the building mechanically cooled ? NO 4 . Percentage of area of windows and doors 11 . 1 A . over 161r Only 1 . Uo value of gross area of walls , roof/ ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? YES NO 1 . If YES , what is the R value ? 3 . Slab on grade YES N.p a . If YES ,d what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation s . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions R-38 2 . R value of exterior walls XXXNX R . 23 . 5 U* =O 04 3 . R value of glazed area U=O . 30 4 . R value of doors R-14 . 9 (U . =0 . 60) 5 . R value of floors over unheated spaces R=1A 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 8 . R value of heated basement/ cellar walls ( above grade ) N/A 90 R value of heated basement/cellar walls ( below grade ) N/A 10 . Type of insulation Fiberglass Co Controls 1 . Thermostat maximum heat setting D . Duct Systems N/A 1 . Is duct system installed in unheated spaces ? YES No a . If YES , R value of duct installation b . . R. value of duct in other areas E . Pipping Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency N/A 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A d Telephone No . { 518) 899-9161 . ( applicant ' s signatu .t APPLICATION FOR suvrIC DISPOSAL PLRYIT Ref: S. P. E. D. S . VATS Octoben 7 �/ 87 permit # MDi]F.L. C of K/C New York - 0202525 LOCATION OF PROPERTY FOR INSTALLATION 27 Margaret Drive Owner's Names Guyer Builders , Ine . Telephones ( 518) 899-9161 Address: 119Dunning Street , Ballston Spa , New York 12020 4utall+es's Names Guyer Builders , Inc Telephone: ( 518) 899-9161 2 A, C, E, I , J, K, L, M Number of bedrooms (residential only) 2 3 F, G, H Total daily now (compute 0 150 gal per bedroom) 300 Topouraphys circle ones tat Rolling Steep Slope % of slope Soil Nature: circle ones Sand Loam Clay Other / Depth:, 8 ' Beet + Cwound Water; At what depth? urda'Own 8 feet + L Bedrock or Isapervious Material: At what depth? unknown feet �tiwn test: circle one: reRquire required / rate min. inch. Ekmxwstic water supply: circle ones Municipal Well Other IF domestic water supply is a Wells Separation: Watersupply from Septic absorption N/A feet * PROPOSED SYSTEMS Septic Tank Sal. (minimum size: 10000 gal.) TILE FIELD: Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S)S Number of / Size each feet by fee+k * Size of stone to be used / Depth or Thickness fact sssss * * sssssssssssssssss �s * s +s► sas * ssssss * * ss I U P O R T A N T * See S . P.E.D. S. ...Please...UST NEW EQUIPM IKNT TO BE INSTALL ECI permit & attached * * sssss * sssss * * sssssssssssssssss * sss * ssss mapw (over) Section U Septic System Inspections: A. All applications for septic system installation, alteration or repair., as required by the Town of Queensbury Sanitary Sewage Ordinances shall be submitted to the Building Department at 1e, t Z4 hours before start , of construction and shall include a plat plan showiu4: 1.) the fropoped .location of the gystem 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply S.) size and dimensions of all tanks, distribution boxers. We fields and/or drywalls B. No system shall be covered before inspection and approval by the builclW Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $260.00. Co An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installations alteration or repair of an approved systems a new proposal must be submitted to the Queensbury Building Department before further construction. I have reaid the regulations above nand agrree to ah"O by thew and all r+egaisemuemts of the Tons of Qureerxslwirg Sanitary► Sewage Disposal Ck+dJuance. Signature of.responsible persons Dater$ * R Town of Queensbury Building and Coda Department Bay at Haviland Road Queensburys New York 12801 (518) ?92-s8sz TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVTLAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (5I8 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FO INSPECTION RE+CETVED_ -' �I NAME � � LOCATION n- / DATE - -ri-' PERM ## d"" 7/ SAC APPROVED YE,-s-.1l NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION1vAMP-PROOFING BACKFILL APPROVAL ROUGH PLVXPING FRAMING ELECTRICAL R GH-IN INS'ULATTON: FOUNDATION FLOORS WALLS VICEILING NAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ST PS STAIRS-CLEARANCE & ILS PLUMBING FIXTURES ELIEF V' VE INTERIOR TRIM/PRI ACY DOORS _ FINISHED FLOORS GARAGE FIREPROO NG DOOR CLOSERS? SMOKE DETECTORS FINAL ELECTRICAL NSPECTION FINAL APPROVAL O CONSTRUCTION A SIGNED CERTIF ATE OF OCCUPANCY MU BE OBTAINED FROM T BUILDING DEPARTMENT EFORE THESE PREMISES OCCUPIED!' REMARKS: o Kam " INSPECTOR _Jn+uvrt v/ Queerr3fiurr BUILDING, and ZONING DEPARTMENT Bay and Havikand Road, R. D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION D icy } 4l'/P•,�.fy �j+'G,.j./// ate L ✓ = APPROVED - YES NO Pootincl/Pier Forms Foundation Watorproo € ing� FA ckf i l l too raminq Roofing Siding Masonry Veneer Rough I'lumbinc3 Relief Valvera Ext , Porches Fist ished Floors .Interior Trim t . tairea & Railings Cellar Drain Tile C'cincrote Floors i'lhrl , Fixtures Y reprr' ofInq :;make. not<'c: torsi chi ley PC)undation floors, Walls L' - ceillnc} P INAL 1•;LECTRICAL IN8kPECTION DRIVEWAY APPROVAL Ftual Building Survey. Next scheduled inspection ( call. when ready ) R, + ina r k s- E ing 1spector - 6/86 rncl-vl .�.lourn o� �es ¢ensL� eertdf BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R-0, i Box 98 7 Q+ueensbury, New York 12801 1 LD I NG INSPECTOR ' S REPORT NAME � ell LOCATION - Date `; - E / Permit Now APPROVED YES NO Footing/Pier Forms Foundation waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves _ Ext . Porches �r Finished Floors Interior Trim 4 Stairs & Railings cellar- Drain Tile Concrete Floors r1bg . Fixtures (aar . Fireproofing, Door Closers ti smoke Detectors� Chimney INSULATION : ; Foundation , Floors_ Walls Ceiling FINAL ELECTRIC#kL INSPECTION W DRIVEWAY APPROVAL. Final Building Survey. -- - ext scheduled inspection ( call when ready ) Remarks- .1 tw GGt4k. VLF✓ "ek 4- Suildin Inspecto G/i3Ea mr3-vl -- _7.1" D/ Quee4" jZUry BUILDING and ZONING DCPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queerlsbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME c ,,.� LOCAT I O ff/AL DATE - PERMIT NO . SOIL TYPE - �_ •'" Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total length Length of each tre ch Depth of trenches Size of gravel_ SEEPAGE PITS4Numb of ) Size- -':F`ft . X fe_ Gravel size - PIPING : f ze r,, Type Bldg _ to tank Tank to dirt . box __ Dist , box to field/ t ' ' t ,. Openings sealed ? No Partial ouDdatioSEPARAT NS oundation to t k .�s ft. oundation to sore ion t . "!Absorption to of li e �! _ft . Separation o pits ..ft. `N7QCATION YSTEM ON PROPERTY ( circle one ) F"ront 3 Le s de - Right side -COMMENTS : 1 L SYSTEM USE APPROVE YES N Bui ding Inspector 01/86 and vl awn 0/ BUILDING and ZONING DEPARTMENT ay and Havdand Road, R. D. 1 Box 98 oueensbury, New York 12801 I DING INSPECTOR ' S REPORT NAME LOCATION Date $ /G` / permit Now APPROVED - YES No Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Ve eer Rough Plumb ' ng _ Relief Valy — --- Ext . Porches Finished F100 Interior Trim Stairs & Railin Cellar Drain Til Lrncrete P'tcxyrs Plbg , Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRI AL INSPECTION DRIVEWAY APPR VAz• --- Final Buildin Survey. 4- Next scheduled inspection (call when ready Remarks- . liniq Bspector 6/86 and-yl f 'J� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date d / Permit hlo . APPROVED - YES NO Forms foundation Waterprco €ing '( Back€ill Framing Roofing Siding Masonry Venee Rough Plumbin Relief Valves Ext , Porches Finished Floors Interior Trim Stairs & Railings Cellar brain Tile Concrete Floors Plbg . Fixtures _ Gar . Fireproofi g Door Closers Smoke Detecto s Chimney INSULATION ; }� Foundation Z_ Floors Walls ceiling fiINAI :LEC RICAL INSPECTION DRIVEWAY A PROVAL Final Build ng Survey Next scheduled inspection ( call when ready ) Remarks-- jJZ rl ew� to Build ng Ins recto 6/86 and VI ✓trwrx o� �ueert .l !' ure� Bl.11l_D1NG and ZONING DEPARTMENT Bay and Haviland Road. R. D. t Box 98 Oueensbury. New York 12801 BUILDING INSPECTORS REPORT NAME LOCATIONLG ante it �+ Permit No . '7 �' APPROVED YES NO �ooting/Pier For Foundation waterproofing Backfill Framing Roofing siding Masonry Veneer Roughs Plumbing Relief Valves Ext . porches Finished Floors Interior 'Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detectors Chimney INSULATION : Foundation. Floors Walls Ceiling F IN AL ELF'.CT CAL INSPECTION -- DRIVEWAY APP OVAL Final Building Next scheduled inspection ( call when ready ) It4marks- „ y �J a � 79 building Insl�e. c o 6/86 and-vl �own v� �uc�er� � hure� r y r BuiL.MNG and ZONING DFPARTMFNT ! F Say and Havifand Road, R. D. i Box 98 r' Queensbury, New York 1280140 BUILDING INSpECTOR ' S REPORT:: � NAME 1-.00A.T I ONfi Date /��{Permit tars . � " pe* * * * * * * * y •* ; APPROVLD - YLS NO ooting/Pier Forms Wunda t ion Waterproof ing Backfill Framing Roof ing siding Masonry Veneer Rough plumbing Relief Valves Ext . porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Til Concrete Floors plhg . Fixtures Gar . FireProo rig Door Closers smoke Detect rs Chimney INsuLATION : Foundation Floors Walls Ceiling -- FINAL ELL TRICAL INSPECTION _ DRIVEWAY A PROVAL Survey Final Build ng Next scheduled inspection (call wlien ready ) Remarks 75 - �' 3 � - �' • tY � �ctor f3uildin9 Insi>� m.9 - V1 BUILDING DEPT. COPY OF APPLICATION FORMI4G-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT, WHEN REQUIRED. CITY OR TOWNSHIP �s'as"'s y COUNTY VILLAGE Qm � STREET AND MO. OR +f POLE NO ROAD AND POLE MO 67 �IBr„g"!I 'L`EtTr� VB BETWEEN WHAT TIMID CROSS STRF ETS IS SECTION r _ BLOCK LOT PREMISES LOCATE 7 ODCUPANT's BUILDING NAME OCCUPANCY OWNERS MAMIE y y .� s TEL. # fi3, AND ADDRESS Qi r �r9 f �v P 119 -^-'ng . SUPPLIED FROM THEIR _ OFFICE BY .. , BUILDING �l OEFECTS IS NEW� OLD © V*SIORK NEW AODITIONAL PREMOVED El LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Na of Finorrr 6 BRANCH OFFICE USE NUM R NUMBER OF OUTLETS Lamp aceptocMs %WTORS HEATERS CIRCUITS ONLY t')on Side Attsd.'t Srrieeh Pendant Braeksx No- Type Ewd1 Nrs` Emote Ne. Go ge INSPECTION Cusum Ile4l Ressp'k Out s Bob- hrss Bsee Iwent IIst Ff. 2nd Ft Srd FI_ REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE, This application is intandwd to cover the abovedisted equipment A ha inspected but if st tuns of inspeietion then is fo ind additional equipment not above listed, 1POMISLOE e owthericed to make Nr* impaction and adjust the fee to aaysr the additional equipment, a1 Prosided by the aPPlicant. ELECTRIC SIG" TOTAL F FEEDERS LAMPS WATTS CTER EXPOSED GAS TUBE SIGN RK CONCEALED TRANSFORMERS OF - A TO BE INUMBERI .ICAPACITYI STARTED CDMPi.£T£D SIZE OF SIGN CE OVERHEADEWIn UNDERGROUND MAKER S OF SIGN I CTION REQUESTED AS NEAR AS NE-w ❑ OLD BLE AVOID DELAY BY GIVING FULL AMD ACCURATE INFORMATION. ALL SPACES DATE OF lo�"7 MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION PRINT NAME AND ADDRESS SIGNAT-UfjE NAME OF OF APPLICj["N°F: - APPLICANTQ&F via STREET ADDRESS ./. -. .. 1119 street TELEPHONE LICENSE NO, POST OFFICE CITY OR CODE _ WHEN APPLICABLE 46 EL (R"- 1I86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING QUEEN VICTORIA'S GRANT QUEENSBURY, NY 2000ga1, I 1 LOT 21 W� Q �t SHUTOFF 1 105.06 MARGARET 8� 0 DIAMETER 9'- 0 DEPTH CLEANOUT TO GRADE ._ 102.00 .._ .,.. 110.00` _ T DRIVE REFERENCE DRAWINGS 5 t; 5A SITE UTILITIES SEPTIC 4 WATER VonDUSEN 4 STEVES SURVEY PLAN 21, 23125,2 029, 1 MARGARET DRIVE VGG T PLAN 4 SEPTIC SYSTEM YER BUILDERS, INC. av- 16 N ; 4q o, ,1-87 Scole : 1"- 20`-0