APA ReferralTown 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, e/o Local Government Services, PO Box 99, Ray Brook, NY 12977
or fax to: (518) 891-3938 or email* to: LocalGovernment@apa.ny.gov
From: C�K-C;L( C{ 0 C �,1 Title: �,�� , Date Sent:
The
Applicant(s): r G West- Var. Application #: fV 3Y
Parcels) Z? . (S - C — l `7 (tax map #)
For: BArea Variance ❑ Use Variance ❑ Septic Variance
Local Zoninz District(s):
The variance involves (check all that apply):
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
®
Other:{-(���
The attached correspondence contains:
❑ Notice of Application ❑ Application Materials ❑ Meeting Minutes
❑ Record of Decision / Decision Date:
Q/Postponed/Tabled (until: I /.--;? / L,2-)-
F1 Granted ❑ Denied
Denied variances do not need to
be 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