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1974- Res. 096~,..:n.~ _,., TOWN OF QUEENSBURY WARREN COUNTY. NEW YORK Application for A MOBILE HOME OUTSIDE OF A MOBILE HOME Mail or bring this application to: Building & Zoning Department Queensbury Town Office Building R.D. 1 Bay Road Glens Falls, New York 12801 This application for a Mobile Home Permit shall be accompanied by a plot plan drawn reasonably to scale showing all dimensions, the size of the lot, the location on the lot of the Mobile Home, the water supply and sewage system. If the applicant is not the owner in fee of the premises, then the application must be accompanied by the written acknowledged consent of the owner. COURT n ~ .i ~ ~ ~I ~; ,~ U ~°: ~ ~ I M~:R `~ ~ ~I~74 ?~8~s;~o~l~~~~~~~z~a~4~5~s ,,l ,.. i. .~/ o N A l d Name of applicant Address Location of mobile home premises by street or road, etc. 1/ / ~ ~! U i1/ ~ c Give nearest cross street 3. _~_o /~c1 / d ~LIG Name of owner of land ~' D~ CC~~s ~,~<<s ~y Owners address 4. State fully the reasons for this request, ~XGf~~v4~ ~ ©~d ~r~Ac~.~~ f~~R ~~ w o`y Use extra sheets if necessary 5. Description of mobile home, year, model, make, serial ~ and dimensions _____ ~q73 C~own~ ~o~i~ 3~~~ J ~ (Applicants signature) Addre s s~ -V/~ THIS SIDE FOR TOWN GOVERNMENT USE ONLY Report of the investigation of Building Inspector and recommendations. }( ~( Approved Disapproved Other : - Recommendations:- I approve this application. This gentleman is replacing an old trailer with a new 1973 model. This is a great improvement. Signed ~'~ Building Inspec or Action of the Town Board Approved Disapproved Other :- By Resolution Number of the Town Board of the Town of Queensbury, Warren County, New York. Dated this day of 19 Signed `~ (Town Clerk, Town of Queensbury ~A~~~-s~a~ ~~