APA Referral AV 49-2020 Rockhurst LLC 1.20.21 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: 6 f V Title:• 7,ont�c ,ors (fir-,- rDate Sent: o'Z io'
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The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): �O G�C� 'sf` LLL= Par.Application #: 14V 9-
Parcel(s) o-- -2-3S (tax map#)
For. ®Area Variance ❑ Use Variance ❑ Septic Variance
Local Zoning District(s): APA Land Use Area(s): ❑ Unknown
/A ) ❑ Hamlet ❑ Moderate Intensity Use ❑ Low Intensity Use
❑ Rural Use ❑ Resource Management ❑ Industrial Use
The variance involves (check all that apply):
® 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:
ER Notice of Application ®Application Materials ®Meeting Minutes
❑ Record of Decision/Decision Date: ❑ Granted ❑ Denied
Denied variances do not need to
JR Postpone&Tabled(until: MG(� ?o';)-) ) be referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
For Agency Use: Agency Date Stamp-Received:
Log#: LV
Cross References:
*Note referrals submitted via email may require follow-up with paper copies. Revised:8/2017