1221 BUILDING PERMIT
TOWN OF QUEENSBURY No. 1221
,- ` WARREN COUNTY,NEW YORK
(")\0\C l PERMISSION is hereby granted to Don Morrell- -
OWNER of property located at 17 Lynfield Drive _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
17 Lynfield Drive
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Same
3. CONTRACTOR or BUILDER'S Address
Same
4. ARCHITECT'S Name
r
Same •
5. ARCHITECTS Address h-h
f+•
Same tD
a
6. TYPE of Construction—(Please indicate by X) -
w
)Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications _ -
N°Sewage System as. per specifications submitted.
8. Proposed Use - V
Sewage System
$ 5.00 PERMIT FEE PAID —THIS PERMIT EXPIRES 8-1- 1971
(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 . 1 Day of June 19 71
SIGNED BY. cI"per gam, for the Town ofQueensburyBuilding an oning InspecCor,/,_
SEWAGE DISPOSAL APPLICATION
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A
SEWAGE DISPOSAL SYSTEM FOR A PRIVATE RESIDENCE WITHIN THE
§ TOWN OF QUEENSBURY
TOWN OFF QU :ENSBLII Y
1. Name nd mailin ddress of applicant: RES .flV1 ,:a. 0
, f,
,,,z,fe uL,
i 7 Jr A- 0, at , . A.M. P.M.
739'10142'1 213140516
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2. Specific location of property:
3. Application is for :
New construction of private dwelling.
Alteration or enlargement of existing sewage disposal system.
.. Description of building:
a. number of bedrooms
b. garbage grinder
(yes or no)
5. Property line dimensions, or total area of property:
6. Topography:
(flat, rolling, steep slope, gentle slope, etc. )
7. 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. ) .
J,4_,_::, . - �Q
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
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.
(Dated) Signatur of applicant