6177 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 6177
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Raymond W. Butler
Corinth Road
OWNER of property located at 144 Street,Road or Ave. (11
rf
in the Town of Queensbury,To Construct or place a Sewage Alteration N
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
R. D. #2
Glens Falls, New York
2. CONTRACTOR.or BUILDER'S Name
Carl Dingman.
Reliable Sewer Service
3. CONTRACTOR or BUILDER'S Address (]
' O
n
N.
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) --
( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications (D
1000 gallon conc. tank, dist. box and dry well
No. laid in stone per application submitted.
8. Proposed Use
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Sewage system for dwelling a
ct.
0
$ 5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES FPh_ 1 19 80
(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 8th Day of November 19 7 9
SIGNED BY AY' 'i'v' for the Town of Queensbury
Building and Zoning Inspector4a7, ,,)
d
•
•
• TOWN OF QUEENSb . .
REGEHE ,,
�y C� TOWN OF QUEENSBURY NOV `7197J
l �J - BUILDING AND ZONING DEPARTMENT A.M. 5°—' P2-c I6
1 BAY AND HAVILAND ROADS RD #1 7I8I9110#11112)112I3)4T5 .'
8ciAl en av�1 ' GLENS FALLS, NEW YORK 12801
6t.rye,
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE .
A SEWAGE DISPOSAL SYSTEM WITHIN THE TOWN OF QUEENSBURY // t + Z
CCCUPANTo S NAME t- ...... „ l 0-- .
TELEPHONE GNNER4 S NAME
ADDRESS • NUMBER OF BEDROOMS
GARBAGE GRINDER? (YES OR I TOPOGRAPHY: �LAT�ROLLING, STEEPS SLOPE,
GENTLE SLOPE, OTHER
NATURE OF SOIL: CLAY, SANDY, LOAM, CRAVE, , ROCKS, ETC.,
PERCOLATION TEST WATER SUPPLY: A ICIPA , WELL, OTHER
DIAGRAM OF PROPOSED SEPTIC SYSTEM
2_,___J 1)c, U c, ,,i2,,,p(---i: ______,.,
70
_ ..) 2.D,,,,,, -,,,_40,./4_:,,R,,,,,i c_,.....-- --
(4
OTHER PERTINENT INFORMATION
IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVED,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN ACCORDANCE
WITH DETAILS SHOWN. r
DATE l//7 SIGNATURE OF APPLICANT '-c-AA,/ i /l -�L
LAKE GEORGE PARK COMMISSION APPROVAL:
(signature)
f:e2.-- /19/
ICE (date? �.
TOWN 4E QU•EENSBURY
Building Department
Inspectors,Rep Date /.
Name ; / st-
Location G/
Permit No. 6 / 7 7 Weather
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
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
Floors
Insulation Foundation '
Walls
Ceilin
;s7''. •
Building Inspector
REMARKS