APA Referral AV 57-2021 West (Table 9.29.21) Town.of Queensbury = Variance Referral to APA.
Agency-approved Local Land Use Program Referral
Please use thisform as a cover sheetforany-correspondence associated with a variance referral to the
Adirondack ParkAgency 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
orfax to: (518) 891-3938 or email*to: LocalGovernment@apa.ny.gov
From: (,r&�Q t�r'o� �:,^ Title:. 47 - �,,,i t,- Date Sent:
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): 6r&tf 100-vief"c_ W'e5f- van Application#.
Parcel(s) ��� I S_ —t '7 (tax map#)
For: CrArea Variance ❑Use Variance ❑ Septic Variance
Local Zoninff District(s): APA Land Use Area(s): ❑ Unknown
( � ❑Hamlet ❑Moderate Intensity Use ❑Low Intensity Use
V`J ❑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 W' Structure Height ❑ Maximum Lot Coverage
❑-Other Shoreline Requirements ® Other: /�,-„v�A Cut ey, ,,; �{,•�;
The attached correspondence contains:
❑Notice of Application ❑Application Materials ❑Meeting Minutes
❑ Record of Decision/Decision Date: ❑ Granted ❑Denied
I r Denied variances do not need to
ag Postponed/Tabled(until: 1 0 l a� be referredto theAgency
Thank you for your assistance in helping to keep the variance decision record complete.
For Azency Use: Agency Date Stamp—Received:
Log#: LV
Cross References:
*Note referrals submitted via email may require follow-up with paper copies. Revised:0017