Application ?� ILE NUMBER:
J v I gd" w� «� R,• / E PAID
TOWN OF QUEENSBURY
531 Bay Road, Queensbury, NY 12804
DEPARTMENT OF COMMUNITY DEVELOPMENT Z
rr
I . PROJECT APPLICANT: n-) rn a
ADDRESS : 7 Sign:sr L o
PHONE # : Home: C
PHONE # : Work:
iov /h: lfo ut�ivS�•w�w D
APPLICANT'S AGENT: C
ADDRESS : 1 op S , 2
C,oK�w7ii z'z
PHONE # : Homez: - 4"731
PHONE # : Work: S,4^f
PROPERTY OWNER: c. 7
ADDRESS:
! r ,�,z GYP �rP i�!` Cr-c����') • `7�`J�
PHONE # : Home:
PHONE # : Work:
DESCRIPTION OF PROJECT: �T `yL!2 �L<a rT�t S X /
DIRECTIONS TO THE PROJECT: Please make as clear as possible,
so oard members & Staff can ind your project:
le
SKETCH OR PHOTOCOPY OF OFFICE USE ONLY
ROAD MAP: Tax Map No.
Zoning:
Variance: A U S No
Site Plan: _Yes No
Subdiv. : _Yes No
CEA: _Yes _No
SEQRA: I, II, Unlisted
Warren Co. : _Yes No
APA: Yes No
Wetland_s : Yes No
II. SITE DEVELOPMENT DATA
Tax Map Number: Section _ Block Lot �
Zone Classification: LAJ J P
Area of Parcel acres = T5AOQ sq. ft.
Maximum Size Building Allowed 1 r)(DO sq. ft.
Disposition of Parcel :
Existing
Building Area sq. ft. % of parcel
Paved Area 2 U pU sq. ft. % of parcel
( including walks)
• Green Area D) sq. ft. % of parcel
Proposed
Building Area j�tL(� sq. ft. % of parcel
Paved Area (( 4 _ sq. ft. % of parcel
(including walks)
Green Area Z R h Q sq. ft. % of parcel
Building Setbacks
Existing Proposed Required
Front Yard
Front (if corner) — —
Side Yard ( 1 )
i Side Yard (2 ) ,f1� — �2, TD
• Rear Yard _—� n i
Rear Yard (2 )
Shoreline
Width
Depth
Access (check where applicable)
Town Highway County State
Length of Frontage (
Number of Parking spaces : Existing 2- Proposed
Town Water: Yes No
Town Sewer: Yes No
Any previous Planning or Zoning Board determination regarding
this property? t-) i)
Present Use of Property: �h; JVn �iiLiC
Proposed Use of Property:
A COMPLETE APPLICATION IS NECESSARY FOR PLACEMENT ON THE PLANNING
BOARD AND ZONING BOARD OF APPEALS AGENDAS - APPLICANT PLEASE READ
The Planning and Zoning Office requires 10 copies of your site
plan or variance application and maps, one original and 9 copies,
along with supporting documentation.
O
In addition to the $25 . 00 fee for site plan applications and m
the $50 . 00 fee for variance applications, the applicant is required n
to pay for the costs related to engineering review. Applications Z
may be referred to the Town Consulting Engineer for review of T
septic design, storm drainage, etc. The hourly rate charge for the O
engineer review will be charged directly to the applicant. Fees
for engineering review will not exceed $1, 000 . 00 without n
• notification to the applicant. ti
O
Other permits may be required for construction or alteration Z
subsequent to approval by the Planning Board or Zoning Board of
Appeals . It is the applicant' s responsibility to obtain these.
I, the undersigned, have thoroughly read and understand the
instructions for submission, agree to the submission requirements
and completed the checklist. Furthermore, it is the practice of
the Department of Community Development to have a designated
stenographer tape record the proceedings of meetings resulting from
applications, and that minutes transcribed from those tapes
constitute the official record of all proceedings . If there is a
discrepancy between such record and the handwritten minutes taken
by the designated stenographer, the handwritten minutes shall be
• deemed the official record.
I HAVE READ AND AGREE TO THE ABOVE STATEMENT
Applicant' s Signature L Date 019F7
Applicant' s Agent Signature /� �,tinrL Date 9 9 7
AREA VARIANCE APPLICATION
(Must be accompanied by site information pages.)
TOWN OF QUEENSBURY
531 Bay Road
Queensbury,NNNew York 12804
Applicant: LXa-lt=�L0 Parcel No. %' / ) 1 31
IN ORDER TO COMPLETE THIS APPLICATION, YOU WILL FIRST NEED:
1 . A map of your property, to scale, showing the location of any existing
buildings, septic systems, and wells. (Remember to indicate North
• and the scale.)
2. A definite idea of where, and what size, you would like your house,
addition, pool, etc., to be.
3. The setback requirements for the zone (available from the Zoning
Department: 745-4436.)
COMPLIANCE WITH ZONING ORDINANCE:
Section(s) / r7 9 / %t!
Require(s) setbacks 0 lot width 0 buffer zone
0 other
that cannot be met by the project as proposed.
• Specific setback requirements should be provided on Page 2 of the Project Information D
z
pages. n-
Z
USING THE MAP OF THE PROPERTY, SHOW:
c
1 . All proposed new buildings, etc., in relation to existing. Show dimensions
clearly. z
2. All setbacks affected by the project, existing and proposed. n
2
3. Distances to adjacent owner's septic and well, if application involves
installation or modification to septic or well, or if it could affect adjacent R'
systems.
4. Other items appearing on checklist with Project Information pages, as
appropriate. (If in doubt, inquire.)
ELEVATIONS:
Some projects are understood better if a drawing of the what the project
will look like is provided, in addition to the map/plan.
Page 2
THE FOLLOWING QUESTIONS REFLECT THE CRITERIA FOR GRANTING THIS TYPE OF
VARIANCE. PLEASE COMPLETE THEM, USING ADDITIONAL SHEETS IF NEEDED.
1. How would you benefit from the granting of this Area Variance?-5-- t.1>n i 1��
h a ue_ li, 6-/2.g if? -e ? o r2 'kf
•
2. What effect would this variance have on the character of the neighborhood and the health,
safety, and welfare of the community? n [J Q F'_ . !�Rp- [) C-2L—FF u
yr4 6t Ll+- - Q C�
3. Are there feasible alternatives to this variance? OL-%-)i rn-1-ht- I�ul t 1� 7��jC1
(LL`) r
4. Is the amount of relief substantial relative to the Ordinance? S7 [)
5. Will the variance have an adverse effect or impact on the physical or environmental n
• conditions in the neighborhood or district? ,{.)i >kA b 'U L"If Cjlfax
_ rr
a
I HAVE READ AND COMPLETED ALL APPLICABLE PORTIONS OF THE PROJECT x
INFORMATION SHEETS, AS WELL AS THIS SIGN VARIANCE. TO THE BEST OF MY
KNOWLEDGE, ALL INFORMATION PROVIDED IS TRUE AND ACCURATE.
4
Applicant: Date: / n
Agent: ' Date:
m
Authorization Form & Official Record of Meeting Statement
If the APPLICANT is unable to attend the meeting or wishes to be represented by another
party, the applicant's signature is needed on the authorization form below, designating an agent.
APPLICANT'S AGENT FORM /
(purl. �Qrt,E�1E�-
I, r'�_�r i a n kzt> hereby designate T_ ?^> > - as my agent
regarding a ® Variance, Site Plan, Subdivision
application for Tax Map Number: Section , Block �, Lot ___Y
•
Applicant's Signature:/Z, id j, Date:
If the OWNER of the property is not the same as the applicant, the owner's signature is
needed on the authorization form below, designating the applicant as agent.
OWNER'S AGENT FORM
I, owner of premises located at Tax Map Number:
• Section , Block _, Lot _ hereby designate as my
agent regarding an application for a 0 Variance, 0 Site Plan, ❑ Subdivision
at the above premises.
Owner's Signature: Date:
Deed Reference: Book Page Date
OFFICIAL RECORD OF MEETING STATEMENT
It is the practice of the Department of Community Development to have a designated stenographer tape record proceedings of
meetings resulting from applications, and that minutes transcribed from those tapes constitute the official record of all proceeding. If
there is a discrepancy between such record and the handwritten minutes taken by the designated stenographer, the handwritten minutes
shall be deemed the official record.
I have read and agree to the above statement
Applicant's Signatum ,6&,2,
Applicant's Agent Signature: Z17 Date:
14.1"(9/95)—Test 12
PROJECT LD. NUMBER
E17.20 S EQ R
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) ,
1. APPU/�q�NT/SPONSOR 2. PROJECT NAME
3. PROJECT LOCATI ,
Municipality (' Counly ill A. PRECISE LOCATION(Street address and road Intersections, pro Inent landmarks,etc.,or provltle map)
5. IS PROPOSED ACTION-
0
Now L7ExPension ❑Modlflcatlonfalteratlon _
DESCRIBE PROJECT BRIEFLY:
7
r
7. AMOUNT OF LAND AFFECTED: A!
Initially aorsa mnmately T r)1:�2 . JCL rr
cres
S. WILL P130POSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EmSTiNGaLAND USE RESTRICTIONS?
El OTHER❑No It No,describe briefly
9. WHAT
JS PRESENT LAND USE IN VICINITY OF PROJECT?
Ild Resldentlal ❑Industrial ❑commeroW ❑Agriculture ❑ParldForesWpen eDaea ❑Olhsr-"-" .
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,Now OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATrE�O�R.LOCAL)?
1=3 Yes ❑No It yes,lbt sgency(s)and permlVapprovais
III' Y �t•j �� % —LJr 1G.7 i� ./.
IT. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? _
❑Yes LT•Flo If yes,list agency name and penNrrapproyal , . _• — - may.,.,_,.:: .
12. AS A RESULT O�F POSED ACTION WILL EXISTING PERMTTIAPPROVAL REQUIRE MODIFICATION?
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE To THE BEST OF MY KNOWLEDGE -
Applicant/sponsor name: 07 - (a j l "u� Date: 2�
SlgnalurFit
/.lug ' T .. _-. .. .. ...
the action is In the Coastal Area, and you are 9 state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
PART II—ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
lVgetafion
CTION EXCEED ANY TYPE I THRESHOLD IN 6 NYC RR, PART 617.e? 11 yes, coordinate the review process and use the FULL EAF.
s ❑No
TION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No.a negative declaration
superseded by another involved agency.
s ❑No
ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Ar•wers may be handwritten.It legible)
isting air quality surface or groundwater quality or quantity, noise levels, existing Irafffc patterns, solid waste production or disposal.
Potential for erosion,drainage or flooding problems? Explain briefly:
sthetic, agricultural•archaeological• historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly:
etation or fauna•fish,shellfish or wildlife species, significant habitats,or threatened or endangered species?Explain briefly:
Ca. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or other natural resources?Explain briefly.
CS. Growth,subsequent development.or related activities likely to be Induced by the Proposed action? Explain briefly.
C6. Long term,short term,cumulative,or other effects not Identified In C1-CS? Explain briefly. '
C7. Other Impacts(Including changes in use'of either quantity or type of energy)?Explain briefly.
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
❑Yes ❑No
E. IS THERE, OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes .•❑No If Yes,explain briefly
PART Ili—DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
!. INSTRUCTIONS: For each adverse effect identified above,determine whether It Is subslandaklarge,important or otherwise Significant.
• -•= Each effect should be assessed In connection with Its (a) setting U.S. urban or rural);(b) probability of occurring; (c) duration; (d)
Irreversibility,(a)geographic scope;.and(f)magnitude.It necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detall to show that all relevant adverse Impacts have been identified and adequately addressed. If
question D of Pan 11 was checked yes,the determination and significance must evaluate the potential Impact of the proposed action
on that environmental Characteristics of the CEA.
❑ Check this box if you have identified one or more potentially large or significant adverse'impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check this box if you'tiave deleimined, based on the Information and analysis above and any supporting
documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts
AND provide on attachments as necessary, the reasons supporting this determination:
•• Name o Lea Agency
Print or Type Name of Responsible Officer m Laa A`ency Tattriol Responsible Officer
Signature of Responsible Officer in Lead Agency sianatuse of Preparers lit differvat fross,responsible o leer)
Date
7
a
- .. .:'. ... _ 'a -. r..:.... .. ... .......a.-. 'c.:..-., ... .C�...1. s s+ �.'� 1. K .�� '��: zd. .':� 'd �'•33..F.�.• > -�s'\ F�-
.. _..� .. _. .. .r. _ ,.-a .-. •_ .,.„:� ....! .. •. ._,.� .. v. ,:i..,*:, �: �v�. .a. ..fi 'r �S._. ty lix ,J�'•^r. tp t
-
-
co
119
_
LL
�
�.}
to
IL
co LL
IL
Id
0Lij
Lil LLCC Is_
Ld
F-
uj
d
0
W Q
LL
- _ . � � � w
w o
�ws, r
R�
Z
ti