APA Referral AV 67-2021 McDevitt (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 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
orfax to: (518) 891-3938 or emall*to: LocalGovernment@apa.ny.gov
From: C�t'G�%�! ry<<�.r1 Title: Date Sent:
J
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Appticant(s): �-5+e v P_ lq'k c�blv:F Pars Application#: -A i
Parcels) (tax map#t'
For: C'Area Variance ❑Use Variance ❑ Septic Variance
Local ZoninffDistrict(s): APA Land UseArea(Js ❑ Unknown
fi ' ❑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
El-Other Shoreline Requirements ® Other: re,"Ivi�: (�cz� �G�, t fi -
l=t��
The attached correspondence contains:
❑Notice of Application ❑Application Materials ❑Meeting Minutes
❑ Record of Decision/Decision Date: ❑ Granted ❑Denied
Denied variances do not need to
(�'Postponed/Tabled(until: `� (v�! 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