APA Town_of Queensbury = Variance Referral to APA
Agency-approved Local Land Use Program Referral
Please use thisform as a cover sheetfor 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 orem" J
ail*to: LocalGovernment@apa.ny.gov /
From: (�drGc c� 6:0c_"r't Title:.Zu,-ii1ji Date Sent: 1�151 i
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): Var.Application#: AV gi-a�d
Parcels) Cl< U. — f — I '7 (tax map#)
For: ❑Area Variance ❑Use Variance ❑ Septic Variance
Local Zonime District(s): APA Land Use Area(s): ❑ Unknown
'Y LC-1 G f) ❑ Hamlet ❑ Moderate Intensity Use ElLow Intensity Use
❑ Rural Use ❑ Resource Management ❑ Industrial Use
The variance involves (check all that apply):
❑ Shoreline Setback ❑ Density [5J Front/Rear/Side/Road Setbacks
❑ Shoreline Lot Width ❑ Lot Size ❑ Road Frontage
❑ Dock/Boathouse ❑ Structure Height ❑ Maximum Lot Coverage
❑-Other Shoreline Requirements ® Other: ,s;Z t✓�ccs� i�l J ar c F 6aZZI.`
The attached correspondence contains:
U/Notice of Application 5r7"Application Materials Bka leeting Minutes
2' Record of Decision/Decision Date: [ 'Granted ❑Denied
Denied variances do not need to
❑ Postponed/Tabled(until: be referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
ForAzency Use: Agency Date Stamp—Received:
Log#: LV
Cross References:
*Note referrals submitted via email may require follow-up with paper copies. Revised:WON