APA Referral AV 62-2021 Civitella (Table 9.22.21) 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 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,%Local Government Services,PO Box 99,Ray Brook,NY 12977
orfax to: (518) 891-3938 or email*to: LocalGovernment@apa.ny.gov
From: Title: ak Date Sent: r'4 J h k�i
The Adirondack Park Agency is hereby notified ofthe receipt of a variance referral record.
Applicant(s): A-jt z,I'-)ic `f' �'�GC r-�G� n U.4 d 4/ Par.Application
Parcel(s) o? '7 1 (tag map#)
For: PrArea Variance ❑Use Variance ❑ Septic Variance
Local Zoning District(s): APA Land Use Area(s): ❑ Unknown
�� ❑ 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 ff Other: FfG-.-
The attached correspondence contains:
❑Notice of Application ❑Application Materials ❑Meeting Minutes
❑ Record of Decision/Decision Date: ❑ Granted ❑Denied
Denied variances do not need to
IR/Postponed/Tabled(until: QGDW% A 21) he referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
ForAffency Use: Agency Date Stamp—Received:
Log#: LV
Cross References:
*Note referrals submitted via email may require follow-up with paper copies. Revised:W017