APA Referral 1.19.22 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, V.Local Government Services,PO Box 99,Ray Brook,NY 12977
or fax to: (518) 891-3938 or email*to: LocalGovernment@apa.ny.gov
From: igrro uOA Title: Date Sent: k;�
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): —D ail b 4e Par.Application #: 4V -2"DoL��
Parcel(s) c2- ,,7, / _ /—t j (tax map#)
For: W Area 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 awly):
❑ 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 CO Other:S; z e of A
The attached correspondence contains:
0 Notice of Application ,0 Application Materials IN Meeting Minutes
fD Record of Decision/Decision Date: ���./�, o'b�� X Granted ❑Denied
Denied variances do not need to
❑ Postponed/Tabled (until: ) be referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
For Agency Use: Agency Date Stamp—Received:
Log#: LV
Cross References:
*Note referrals submitted via email may require follow-up with paper copies. Revised:8/2017