APA Referral AV 20-2022 (Carlson) 5.18.22Town. of Queensbury - Variance Referral to APA
Agency -approved Local Land Use Program Referral
Please use this form as a cover sheet for any correspondence associated with a variance referral to the
Adirondack Park Agency as provided for in the Town's Agency -approved Local Land Use Program.
Send this cover sheet & variance referral record to:
Adirondack Park Agency, `/o Local Government Services, PO Box 99, Ray Brook, NY 12977
or fax to: (518) 891-3938 or email* to: LocalGovernment@apa.ny.gov
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From: � t- ,moo w r2 Title:. 0 ,-q i y,, c n��ces �` f Date Sent:
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): re"G (_G.O 15c> r7 Yap Application #. AV -2c
Parcel(s) a3 q, (3 — F 4 (tax map #)
For. ® Area Variance
Local Zoning District(s):
Ile
The variance involves (check all that apply):
❑ Use Variance ❑ Septic Variance
APA Land Use Area(s). ❑ Unknown
❑ Hamlet ❑ Moderate Intensity Use ❑ Low Intensity Use
❑ Rural Use ❑ Resource Management ❑ Industrial Use
❑ Shoreline Setback ❑ Density ®'Front/Rear/Side/Road Setbacks
❑ Shoreline Lot Width ❑ Lot Size ❑ Road Frontage
❑ Dock/Boathouse (?' Structure Height ❑ Maximum Lot Coverage
❑ - Other Shoreline Requirements C"Other: �,,�to °�-G��4.i�� less k, , to. -Fr. -jQ,,-n, 0A,
The attached correspondence contains:
CO'Notice of Application C"Application Materials BIMeeting Minutes
❑ Record of Decision / Decision Date:
RP7l/ ostponed/Tabled (until: ,�26
❑ Granted ❑ Denied
Denied variances do not need to
he referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
ForAzency Use:
Log #: LV
Cross References:
Agency Date Stamp — Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 8/2017