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APA Referral AV 58-2021 West (Table 9.29.21) 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,V.Local Government Services,PO Box 99,Ray Brook,NY 12977 or fax to: (518) 891-3938 or email*to:LocalGovernment@apa.ny.gov From: �_ al Title: �� ►� �cStYcc �- Date Sent: The Adirondack Park Agency is hereby notified of the receipt of a variance referral record. Applicant(s): 6rt• - Piggy z{6L (,A)-est Pan Application#: AV Parcels) (tax map#) For: C'Area Variance ❑Use Variance ❑ Septic Variance Local Zoninff District Os APA Land Use Area(s): ❑ Unknown ❑ Hamlet ❑Moderate Intensity Use ❑ Low Intensity Use (�11 ❑Rural Use ❑Resource Management ❑Industrial Use The variance involves (check all that apply): C'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: ❑ Granted ❑Denied r Denied variances do not need to IR/Postponed/Tabled(until: he 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:8/2017