Application TOWN OF QUEENSBURY IL- E , BER
DEPARTMENT OF COMMUNITY DEVELOPMENT
DIVISION: ZONING D TE REC'DJFEE PD
531 BAY ROAD h�
QUEENSBURY, NEW YORK 12804-9725
(518) 745-4436
1 . Applicant's Name: ao'o 'Z5wzU\nnf
Street Address : N.0-mr0hr.�
City, State, Zip: �, bc\ ON 1-2-WA
Telephone No. (SIY)1R3 3 [ 3
2 . Agent's Name:
Street Address :
City, State, Zip:
Telephone No.
I�
3 . Owner's Name: Dov.d Suzrnne 6orne5
Street Address : N C�urchl-Ocn-�,
City, State, Zip: )bk Q-B0y
Telephone No. ���� ri 31A7•
4 . Location of property: �Y,��uru. Qy2h�t �` Zerne QOc.d
5 . Description of how to find the property: 5e R!-Up
6 . TAX MAP NUMBER: Section } /1 7 , Block 'Y _, Lot / /`J
7 . Zone Classification: }211 Lot size: �J4, va acres/sq. ft.
B . Section(s) of the Zoning Ordinance from which you are seeking
this varian e:
9 . Present use(s) of property: N"Au sg Rg or ohq _
10. Proposed se of property (the change you will be making) :
26RA) 5\,xn A CXkSk w gi O ', ctlY ,P-0 \•C ho-0.
11 . Is the property in question within 500 feet of a County or
State Right of Way, Park, Municipal Boundary, or Watershed
draining any County or State facilities, requiring review by
the Warren County Planning Board?
YES _ NO
1
12 . List the names and location of the parcel (include tax map
number and zone) of adjoining property owners .
_`,I Name: L.ttz�rne RDWA
.+ Tax Map #
Zone W-S
NORTH ���
Name: 111Iv�o�S A��ex�v.�. � Name:
Tax Map # WEST -1� EAST Tax Map #
Zone MILS Zone MRS
SOUTH
Name: �—rt (mA)6) o G� �
Tax Map #
Zone MILS
PLEASE answer the following questions. Attach additional
sheets if necessary.
13 . Is a reasonable return possible iF the land is used as zoned?
YES
\\ NO
EXPLAIN: N1e e,hS�mG auF� �Doc�V tCOu�r �1op -
14. Are the circumstances of this lot unique and not due to the
unreasonableness of the Ordinance?
YES NO EXPLAIN: 4rU&r2 2A\sW pc»Ao o-&yNtA
ov-&%YNCnraG'z-
15. Is there an adverse effect on the neighborhood character?
YES \� NO \
EXPLAIN: 5eve -m\ bvS�reSSGS fX�ST \n Ges,r C� ec!sn n
16 . Other comments:
2
J
PLEASE ATTACH THE FOLLOWING ITEMS TO YOUR APPLICATION
17 . A site plan showing existing and proposed features of the
property, including:
A. lot dimensions DRAW TO SCALE: preferably 1 Inch equals 40 feet or less
B. north arrow and scale
C. location and dimensions of existing and proposed
buildings, showing setback distances and uses
D. parking layout to scale
E. physical features (streets, steep slopes, lakes,
wetlands, etc. )
F. location of water and sewer system, if applicable
G. easements and public roads
H. adjacent ownershi
Mr. and Mrs . First Last Name
Street Address
Queensbury, New York 12804
TAX MAP NO. 120-01-8.9 NOTE: Diagram is used as an example only.
SCALE: 1" = 30' Not all possible information depicted (shown).
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LOCATION MAP
MESSAGE TO THE APPLICANT(S) AND/OR AGENT
Please return the ORIGNAL APPLICATION THAT IS FILLED OUT along wit copies In total
we required 10 sets of your application.
A complete application includes this application form filled out , a variance site plan with
narrative and supporting reports, if applicable.
Please fold your accompanying maps (variance site plan) to at least an S 1/2 by 14 inch or
smaller format.
Substantial information needs to be submitted as required for placement on the Zoning Board of
Appeals agenda.
IF YOU HAVE ANY QUESTIONS, PLEASE GIVE US A CALL OR STOP IN TO SEE US.
(518) 745-4436.
SPECIAL NOTE: Other permits may be required for construction or alteration subsequent to
approval by the Zoning Board of Appeals. It is the applicant's responsibility to obtain these
permits.
11 -------------------------- HAVE READ THE ABOVE AND UNDERSTAND THE ABOVE
MESSAGE.
SIGNATURE OF APPLICANT) =
SIGNATURE OF AGENT:
--------------------------------------------
DATED THIS ----_� -- DAY OF y�j�---_—_ — YEAR
4
QUEENSBURY ZONING BOARD OF APPEALS CHECKLIST
A. Title of drawing, including name and address of applicant and
person responsible for preparation of such drawing.
B. North arrow, scale, and date DRAW TO SCALE: perferably 1 inch equals 40 feet or less
C. Boundaries of the property with dimensions in feet, including
zoning boundary delineations .
D. Existing watercourses, wetlands, and other waterbodies.
E. Location of all existing principle and accessory structures
and their uses with exterior dimensions and lot line and
waterfront setbacks .
C F. Location of all proposed principle and accessory uses and
structures with exterior dimensions and setbacks.
G. Location of any existing or proposed easements, driveways,
outdoor storage and refuse containment areas, including
setbacks and dimensions of said structures, etc.
H. Location of existing and proposed sewage disposal facilities,
including lot line, waterfront and well setbacks. Also,
location of existing sewage and water systems on adjoining
lots.
I . Location and description of existing public or private water
supply.
J. Description of the method of securing public or private water
and location.
K. Location and design of all existing and proposed parking and
loading areas, showing driveways, ingress, egress, handicapped
parking and curbing.
L. Total number of existing parking spaces, including the number
of those to remain or to be removed, those to be paved, those
to be graveled, and total number of proposed new paved spaces
and proposed graveled spaces, including basis for determining
parking adequacy.
M. Location, design, and construction materials of all existing
or proposed site improvements; including drains, culverts,
retaining walls, and fences.
N. Location, setbacks, and size of all existing and proposed
signs; including design and construction details of proposed
signs.
5
O. Location and proposed development of all buffer areas,
including existing vegetative cover and screening of storage
or refuse areas .
P. Location and design of all existing and proposed outdoor
lighting facilities.
Q. Identification of the location and amount of building area
proposed for retail sales or similar commercial activity.
R. If applicable, the applicant is required to submit a MATERIAL
SAFETY DATA SHEET (MSDA) as required by the Environmental
Protection Agency. The list must include the chemicals and
hazardous materials to be stored and used on site and the
quantities of such. The plan presented to the Board must show
any storage and containment areas.
S. General landscaping plans .
T. Other elements integral to the proposed development as
considered necessary by the Zoning Board of Appeals.
U. The applicant is required to accurately identify all setbacks
between buildings and the property boundaries. All areas
where variances are required need to be clearly identified and
accurately measured.
EXISTING SETBACK PROPOSED SETBACK
(feet) (feet)
SIDE YARD:
FRONT YARD(1): (o�j fprj
FRONT YARD (2):
(II comer lot) l o 0 g 1
REAR YARD: y l{b :9
SHORELINE: —
TOTAL SQUARE FEET: �(o p `C!'f fy- P9-5)0b7'C
NOTE TO APPLICANT(S) AND AGENT:
Please address all of the Items on the checklist. If an Item on the checklist
does not apply to your particular proposal, mark.Na'(not applicable) next to
the Item.
If the required substantial Information Is not Included In the submission, the
application will be removed from the agenda.
I, Q��yQ_Pil .L.-;7 have reviewed the above checklist and
NOTE TO APPLICANT an nde dd what is required for completion.
Signature of Applicant: 5�-�-'-s+ :`----- Date ---
Signature of Agent: ----,_---------- Date
6
AUTHORIZATION TO ACT AS AGENT FOR
I, _______________________ (SELLER, OWNER) OF PREMISES LOCATED
AT TAX MAP NUMBER
---------------------- ----------------------
HEREBY DESIGNATE:
---------------------------------------------
AS MY AGENT REGARDING AN APPLICATION FOR A VARIANCE AT THE
ABOVE PREMISES.
DEED REFERENCE BOOK: PAGE: DATE:
-------------- -------- -------
( DOES THE ABOVE PARCEL REPRESENT OWNER'S ENTIRE CONTIGUOUS
HOLDINGS? PLEASE ATTACH EXPLANATION.
SIGNED: DATE:
PLEASE READ BELOW AND SIGN
THE PARTIES HERETO CONSENT THAT THE PROCEEDINGS WHICH RESULT
FROM THE WITHIN APPLICATION MAY BE TAPE-RECORDED BY THE
DEPARTMENT OF COMMUNITY DEVELOPMENT'S DESIGNATED
STENOGRAPHER AND THAT SUCH MINUTES AS MAY BE TRANSCRIBED
t SHALL CONSTITUTE THE OFFICIAL RECORD OF ALL PROCEEDINGS
REGARDING THIS APPLICATION, UNLESS THE SAME MAY VARY FROM THE
HANDWRITTEN MINUTES TAKEN BY THE DESIGNATED STENOGRAPHER, IN
WHICH EVENT THE HANDWRITTEN MINUTES AS TO SUCH INCONSISTENCIES
SHALL BE DEEMED THE OFFICIAL RECORD.
APPLICANT'S SIGNATURE:9/Z,--
AGENT'S SIGNATURE:
-----------------------------------------
DATED THIS ___a7_____ DAY OF _�p � , YEAR
YPROJECT I.D.NUMBER 617.21 SEAR
' Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (ro be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR 2. PROJECT NAME
utl0 Z ,4 BJ
3. PROJECT LOCATION:
Municipality pjt(jk County b
wmfialy
4. PRECISE LOCATION(Street address end road I tersectlons,prominent landmarks,etc.,or provide map)
1CYOi*/rdJ' +JA'
C'?4A-A'y-7 ley
6. IS PROPOSED ON�
El ACT) Expansion ❑Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
�.X�.A�YA//Y�s• Y%2rl7'l7lYro- C'b:h vx� �JU.6t j3W��-��Nlr
7. AMOUNT OF L4ND AFFECTED:
Initially .agLes Ultimately &:16 .awes
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Dyes ANo It No,describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
KResldentlal ❑Industrial Commercial ❑Agriculture ❑ParkfForest/Open space ❑Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?
❑Yes PNo If yes, list agency(s)and permitlapprovals
1
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes ONo If yes,list agency name and permittapproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
Dyes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE /
Applicantisponsor name: 1�'/b�c/., 51'0 9L aE2.gV'0y .>:' f3Af//e:;r Date: / s3
Signature• C C �/
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
1
PART II—ENVIRONMENTAL ASSESSMENT (ro be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.12? If yes,coordinate the review process and use the FULL EAF. —�
❑Yes ❑No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration
may be superseded by another Involved agency.
❑Yes ❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,It legible)
Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erosion,drainage or flooding problems?Explain briefly.
C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly:
C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly:
C4. 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.
C6. 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•C6?Explain briefly.
C7. Other Impacts(Including changes In use of either quantity or type of energy)?Explain briefly.
D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No If Yes,explain briefly
1
PART III—DETERMINATION OF SIGNIFICANCE (ro be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether It Is substantial,large,Important or otherwise significant.
Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c)duration; (d)
Irreversibility; (a)geographic scope; and(Q magnitude. If necessary,add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed.
❑ 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 have determined, 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 of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from responsible officer)
Date
2
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