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5742
BUILDING PERMIT TOWN OF QUEENSBURY No. 5742 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to George Champion OWNER of property located at 108 4th St. Ext, Street, Road or Ave. O' I-I 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 C] approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 5 1. OWNER'S Address is 108th 4th St. Ext. Glens Falls. New York 2. CONTRACTOR or BUILDER'S Name Daniel Drellos 3. CONTRACTOR or BUILDER'S Address 53 Fourth St. Glens Falls. New YorkCo H 4. ARCHITECT'S Name rn 5. ARCHITECT'S Address Gd X rt' 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications No. 1200 gallon dry well per application U) m 8. Proposed Use A�- Sewage alteration for dwelling IL H rh m $5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 1 19 79 (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.) F-" O Dated at the Town of Queensbury this 2 OthDay of April 19 79 SIGNED BY ` for the Town of Queensbury Building' nd Zoning Inspector ��' TOWN. OF QU:EENSBURY Building Department �7 Inspectors Report Date 4 /7 // Name Z-ef._ 9 ,` _� !Y�, Location /.� >'G // V t Permit No77� 'rr9�✓1.r� +:, Weather 57 I/ Per Cent • Complete Remarks Excavation Footing Forms Footing & Piers Foundation Cement Coat Waterproofing Backfill Final Survey Framing Sheathing Roof Felt Roofing Siding Masonry Veneer Rough Plbg. Rough Htg. Relief Valves Wall 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 v Building Inspector REMARKS /} TOWN OF QUEENSBURY TOWN OF OUEENSBURY n E I . V I 1Y BUILDING AND ZONING DEPARTMENT uu r\pp 2 0 1979 BAY AND HAVILAND ROADS, R. D. #1 ��o �-�� pc( GLENS FALLS, NEW YORK 12801 A.M. M' 71M11011kM-PI3) IM A APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A SEWAGE DISPOSAL YSTEM WITHIN E TOWN OF OUEFNSBURY /o ? NAME ADDRESS y7 OCCUPANTS l TELEPHONE OWNER'S N KE _ ADDRESS NUMBER OF BEDROOMS 3-- 3- GARBAGE GRINDER? (YES OR NO,. TOPOGRAPHY: FLAT, R0LLIN(°, STEEP, SLOPE, GENTLE SLOPE, OTHER NATURE OF SOIL: CLAY. SANDY.' LOAM, GRAVEL, ROCKS, ETC. PERCOLATION TEST WATER SUPPLY: MUNICIPAL; WELL, OTHER. DIAGRAM OF PROPOSED SEPTIC SYSTEM S?MD-77"75 dAd- 6VC • h00 s -e OTHER PERTINENT INFORMATION IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROV••D, INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN ACCOT©ANCM WITH DET ILS 'HOWN. • DATE 17 SIGNATURE OF APPLICANT ' - LAKE GE RGE PARK COMMISSION APPROVAL: • s� a-,�ature tf'R_40-