APA Referral Sheets 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
or fax to: (518) 891-3938 or email*to: LocalGovernment@apa.ny.gov
From: Ctl Orowol Title: jrlt ry2�s-(Y Date Sent: i ao33
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): re,,If 4- 'rcb► i-da. Oeg+- Par.Application #: A✓ 5`7 Ob,3 t
Parcels). �5 -I -/ 7 (tax map#)
For: ["Area Variance ❑ Use Variance ❑ Septic Variance
Local Zoninz District(s): APA Land Use Area(s): ❑ Unknown
` ❑ Hamlet ❑ Moderate Intensity Use ❑ Low Intensity Use
(/,�,�v► ❑ Rural Use ❑ Resource Management ❑ Industrial Use
The variance involves(check all that apply):
Shoreline Setback ❑ Density ErFront/Rear/Side/Road Setbacks
❑ Shoreline Lot Width ❑ Lot Size ❑ Road Frontage
❑ Dock/Boathouse ❑ Structure Height ❑ Maximum Lot Coverage
❑-Other Shoreline Requirements 9 Other:Sf,,-mw&-4--r devi-ce- le5s-(,n roo 4.
na C7C c 2 Pp,-4- eocAe-r
The attached correspondence contains:
[04�otice of Application 2-A"'pplication Materials "eeting Minutes
❑ Record of Decision/Decision Date: ❑ Granted ❑Denied
y� Denied variances do not need to
C/Postponed/Tabled (until: _!J a,-c kt 16 2,D he referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
For Azency Use: Agency Date Stamp—Received:
Log#: LV
Cross References:
*Note referrals submitted via email may require follow-up with paper copies. Revised:8/2017