APA Referral 1.26.22 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
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or fax to: (518) 891-3938 or email*to: LocalGovernment@apa.ny.gov
From: eF_6iA Title: Zof1 _I� ti�il�K�S�Y�.�t r Date Sent: 0/ 'Po _
The Adirondack Park Agency is hereby
notified of the receipt of a variance referral record.
Applicant(s): G ll� . t reon n o r5 Par.Application #: A -3
Parcels) 7. — - 1 (tax map#)
For: 0 Area Variance ❑Use Variance ❑ Septic Variance
Local Zoning District(s): APA Land Use Area(s): ❑ Unknown
'j ❑ Hamlet ❑ Moderate Intensity Use ❑ Low Intensity Use
(/V ❑ 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
❑-Other Shoreline Requirements ❑ Other:
The attached correspondence contains:
®Notice of Application 0 Application Materials 0 Meeting Minutes
�l Record of Decision/Decision Date: .® 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