6386 BUILDING PERMIT
TOWN OF QUEENSBURY 6386
No.
, WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Jeffrey Combs
U
Montra
OWNER of property located at Q� Y Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration ,-C
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. O
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1. OWNER'S Address is 38 Montray Road
Glens Falls, N. Y.
2. CONTRACTOR or BUILDER'S Name
Same
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3. CONTRACTOR or BUILDER'S Address co
Same1-1
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address 0.'
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
1000 gallon conc. septic tank, dist. box,
No. 4 'x5 ' seepage pit and #r3 stone per
application submitted.
8. Proposed Use O
Sewage system for dwelling.
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5. 00 October 1 rt.
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19 8 0
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(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 9th Day`of June 19 80
SIGNED BY e ( P for the Town of Queensbury
Building and Inspector C
TOWN OF OUEENSBURZ
BUILDING AND ZONING DEPARTMENT TOWN OF QUEENSBUe;:.
Brit AND I3AVIL, !3. D ROADS, R.D. .I '
GLENS �a�1LLS, NEW ?OR) 128 0 pry
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Ni 1980
PPL ICA"!ION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE
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A SEWAGE DISPOSAL SYSTEM WITHIN THE TOWN OF OUs. ENSr UR`Y A.M. P.M.
OCCUPANT'S NAME eSculkl,.. aopia.)10, .s ADDRrss_aulLtrAilaqM
TELEPHONE 19 =3 r1 o._OWNER'S NAME e.C).k. 4.`E'1 J d
ADDRESS.._ °tI L `) ..,_ 1� -_- - -1 �� �`p( NUMBER OF BEDROOMS______R____
GARBAGE GRINDER? 'L CAS OR NO) TOPOGRAPHY: FLATi ROLLING, STEEP, SLOPE
GENTLE SLOPE, OTHER. C_2ATA .g..„ per _ _
NATURE OF SOIL: CLAY, SANDY, Z,O ) GRAVEL, ROCKS,
PERCOLATION TEST WATER SUPPLY 2 ' MUNICIPAL GTELL, OTHER 2
DIAGRAM OP PROPOSED SEPTIC SYSTEM
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OTHER PERTINENT INFORMATION / � L � �� ._. Ae
IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVED,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN ACCORDANCE
WITH DETAILS S IGrnN
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DATE.�.v /J�`,[�j SIGNATURE OF APPLICANT �_.._.�_..
V
LANE GEORGE PARK COMM/SS ION APPROVAL:
(signature)