1974- Res. 138v'~ !~ ~..
TOWN OF QUEENS~URY
~~ WARREN COUNTY, NEW YORK
I'~ Application for
A MOBILE HOME OUTSIDE OF A MOBILE HOME TaF ouEENSSURY
flail or bring this-application. to: ~`~
D
:Building & Zoning Department APR 2419]4 l~
Queensbury Town Office Building: ~~~~ ~ L~~1,
R.D. 1 Bay Road A.M. P.M.
7~8~9i10~11~12~1~2~3~4~6~6
Glens Falls,.New York 12801.
-,This application for a Mobile Home; Permit shall be
accompanied by a plot plan drawn reasonably to scale.
showing ell dimensions, theesize of-the .lot, the location
on the lot of the. Mobile Home, the water eupply 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.
~. L 1 N~~ C PA,~~~~
Name of applicant
l D R t'~VG',k- sT ~.C~ii/S ~iQ~,cs
Address '
Location of mobile home .premises by street or road, etc.-
~~ ~ L'~FiyT "~i ~4 ~ ~ y~! G ~,~ws f=,~ l ,c s
Give nearest cross street
3. ,~~'f3 R~4 .C,~'E TRD/41.~~C,E' l
Name of owner. of land
Owners address
~ 4. State fully the reasons for this request~_~~
1Y~...~~'~ /~ O Tiy~i~ N~/`i~0 / 5 ,~4 D/~4R.ET/GD,
~1~.[~LF.Q ,L /y~S '1~%:4~DN~9.~~ / .9~~i ASS
ADM ~~o Pos~I~ Ap~.~/~'~.vTS ~,FQ~1.EST.~D
__~__
APP~I~~a/T T.~ i/•~A R DER /yDhC/~~
- RkT/ RED .,~ ~,E ro ~is~ 8~~ ~r~,
Use extra sheets if necessary
i
5. Description of mobile home, ear, model, make, serial
1 # and dimensions ~~ /TZ L, ~~}FT
~, ,
' (Applicants signature)
Address ~ u ~ ~.c~.~~1~r~ A ~~
c~x~o
~~~~ ~ ~
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