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`G - 'ram w✓1 Title: ,,�),,� y .���, Date Sent:
J
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): Pe) � U-J Deyd eed— Far. Application #: AV
Parcel(s) 62,Q %. R ' l ` S� (tax map #)
For: 2--Area Variance ❑ Use Variance ❑ Septic Variance
Local Zoning District(s):
W 9
The variance involves (check all that apply):
Shoreline Setback
❑ Shoreline Lot Width
❑ Dock/Boathouse
APA Land Use Area(s): ❑ Unknown
❑ Hamlet ❑ Moderate Intensity Use ❑ Low Intensity Use
❑ Rural Use ❑ Resource Management ❑ Industrial Use
❑ Density
❑ Lot Size
❑ Structure Height
Setbacks
❑ Road Frontage
❑ Maximum Lot Coverage
❑ Other Shoreline Requirements &O'Other:.Sta'-"n'.74-kef Atw4- F �--r
The attached correspondence contains:
O'gtotice of Application C9"Application Materials
❑ Record of Decision / Decision Date:
E Postponed/Tabled (until: 51% 6 ��e 114 `i )
❑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.
ForApency Use:
Log #: LV
Cross References:
Agency Date Stamp - Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 8/2017