APATown 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
From: �,�feu a 6 6titt).11 Title:.Z.011i�y A ants � Date Sent. 3 I D'O a3
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): 5 So, -is a�-J "(" Par. Application#: A�l
Parcels)
a?3--y, /'Q - '�; -
For. M-Area Variance
Local Zoniniz District(s):
The variance involves (check all that apply):
(tax map #)
❑ 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: ��v: �h w4d-e.-!)e c,�- 5��6e c-4:�j � o^ c'f cz
The attached correspondence contains:
O Notice of Application ErApplication Materials
❑ Record of Decision / Decision Date:
ffPostponed/Tabled (until: MAl /'7, -;b 3 )
O'Meeting Minutes
❑ 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.
ForAyency Use:
Log #: LV
Cross References:
Agency Date Stamp — Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 8/2017
Town, 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: �(-cXl d Ot-o vo r1 Title: � tY4'�rrt fs fi or Date Sent. �� l:P-3
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): 5 set-1-5 e5w� OWL( )-� Par. Application # { y � 9c'•aa
Parcel(s) 921, J (tax map #)
For: 0 Area Variance
Local Zoning District(s):
The variance involves (check all that apply):
❑ Use Variance ❑ Septic Variance
APA Land UseArea(s): ❑ Unknown
❑ Hamlet ❑ Moderate Intensity Use ❑ Low Intensity Use
❑ Rural Use ❑ Resource Management ❑ Industrial Use
la" 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 Er Other: Fir» eej,'lI -"/ .1 oF/i or7G�n
The attached correspondence contains:
C `Notice of Application ❑Application Materials Br'Sleeting Minutes
❑ Record of Decision / Decision Date:
B"Postponed/Tabled (until: � � / a--3 )
❑ 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.
For Azency Use:
Log #: LV
Cross References:
Agency Date Stamp - Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 8/2017