Application _-. -.. -...... .... .... .� .no WJ UUJ/UUS
- TOWN OF QUEENSBURY
742 Bay Road, Oueensbury, NY 12804-5902 518-761.8201
RECEIVED�.�
F:=:3 2 q LIJQ
FRFSHWATER WETL S PERMIT APPLICATION TOWN OF QUEENSBURY
PLANNING OFFICE
APPLICATION NO.: PII�2 L o2l-W-3
APPLICATION DATE:
This is an Application for a Permit to conduct/cause to conduct a regulated activity on or
adjacent to a freshwater wetland pursuant to Freshwater Wetlands Protection Law - Local
Law 1, 1976.
TO: Town Clerk of the Town of Queensbury -Please immediately forward this application
to the Planning Board of the Town of Queensbury by way of service upon the Planning
Department of the Town of Queensbury,
TO: Applicant - Please type or print the information required and complete all blanks and
answer all questions. If the information requested is not applicable, please enter N/A. Please
provide the original_plus 14 copies ofthis application with a$IOO anp ication fee.
# F F k F F F F F F rt rt rt rt rt F rt # # # # # # F F F F F F F 4 F t F rt rt rt rt F rt rt F F # F F F
WORMA77ON FOR APPLICATION
Applicant: �ccc 1 /l
Name: 1A0S ^n4" DQ,xAoe rvie,t lr 7.
Address', 1-1 S 7 6a n j ro( k\v-<
�tba�h N� Izz-os
Phone: 8!��i — 3 7-t 8
Property Information:
1. Name of wetland or any body of water/stream involved:
4 4spe< M(eE 1.»� ter- ICI — NCAVVJV 1 �B too
2. Address of parcel upon which wetland is located and address of parcel(s) upon which
work is proposed.
"HOME OF NATURAL BEAUTY. . .A GOOD PLACE TO LIVE'
SETTLED 1763
02/21/2003 FRI 15:18 FAX 16004/005
3. Tax Map No. of parcel upon wetland is located and Tax Map No. of pared upon
which work is proposed: Zc?eo. 20 - /—2-
4. Currant zoning of parcel upon which wetland is located and current zoning of parcel
upon which work is proposed: E/G / A
5. Total area of property upon which work is proposed: 4-2'9 N"vo
6. Total area of wetland: t.?—(4
7. Dimensions of wetland: 4
S. Existing uses of wetlands, if any:
Nam»
9. Adjacent uses within 400 ft. of wetlands,if any: _ (�6 m m e✓eta
10. State, County, Town property within 500 ft. of wetland: /
Quin-ems `Zi 'oc.d, �iN n+�,._ywn2cL
rmation About the Project:
1. Detailed description of proposed activity:
2. Purpose, character and extent of proposed activity upon or adjacent to wetland:
Q--a8,�-�.� 5��-e....o11C Lei..}.�.,1.. 12 U.oy1 14 �-✓%b Cl,s +
Gle 60.ie LAnckP— N Lt5 C-'<
rm T O -Oe4 - pyo
3. On a map to be submitted with this application, show the area of the Beshwater
wetland or adjacent area directly affected with the location of the proposed activity
shown to scale thereon as well.
4. Will the project require any other Federal, State or local pemiits7
5. Has work begun on the project? NO
6. Approximate starting date of project? ! nn Z,-b 3
7. Approximate completion date of project? }e Zyc 3
02/24/2003 MON 11:24 FAX 10002/002
FED 24 2003 11: 41Rh HF&SERJET 3200 * p. 2
11;11 MA
' @I005/006
Lilt the names of the owners of reoofd of lands adjsoetn 10 the p'ed►walor wetland of adjaoeot
area upon wl:ch the protect is m bo undertaken:
I.�kd
Name of cbimmts Of vwtsr righri vfhich you have Imbood and which rdste to any Istd wift
of whfie 100 R. of the bouodwy of the property on whkh the proposed rnWated sedvlty vua
be located;
No n 04k4. -K-n -A ad.'4ce,. nkinews
•� •� � � �f�1• • �.I� � � �f4�4 •�IAfM�4� �f •Ii1•♦t� a�tiri • � 1.
The ftMOing istbtmation wN be reviewed by the sowxy, and dw agmry, may V it dowcat
request any further btlbrroation noogsety to Mahe s deddoe.
I ha*y of m under pandty of perjury that the Wortmtion provided herein and all
attadbmaea a6wited bwcwMkue to the best ofmy wWpe belief:
x oF�Mll ' �L' (J6(.�9J'TEiJI"
I hereby aulhotize a dgny.17 ems.h j -'?-C.to 641 as my agog end repreteea me
in o0mvettion with this application on my behalf