APA 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
(Ir-i& a
orfax to: (518) 891-3938 or email*to: LocalGovernment@apa.ny.gov
From: 6 r-p�,'t Title:.Zpq t'J QivLcn i 'c Cis Date Sent: 113 1
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): andmill-0 'i- ma&z�( (v;472fC ta_ Var.Application #: A-V 6.;' 1
Parcels) a 3 1 '7 - /- 20 (tax map#)
For: 59 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 apply):
❑ Shoreline Setback ❑ Density Er Front/Rear/Side/Road Setbacks
❑ Shoreline Lot Width ❑ Lot Size ❑ Road Frontage
❑ Dock/Boathouse ❑ Structure Height ❑ Maximum Lot Coverage
❑-Other Shoreline Requirements ® Other: l a�rtc� Pef.�►��lam;l,"{� �n-�' /�r�, �,•�
The attached correspondence contains:
A Notice of Application ER Application Materials JQ Meeting Minutes
J1 Record of Decision/Decision Date: B Granted ❑ Denied
-k P v.,, /f J6/tea 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
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 ParkAgency as provided for in the Town's Agency-approved Local Land Use Program.
Send this cover sheet&variance referral record to:
Adirondack-Park Agency,%Local Government Services,PO Box 99,Ray Brook,NY 12977
orfax to: (518) 891-3938 or email*to: LocalGovernment@apa.ny.gov
From: Title: ak Date Sent: r'4 J h k�i
The Adirondack Park Agency is hereby notified ofthe receipt of a variance referral record.
Applicant(s): A-jt z,I'-)ic `f' �'�GC r-�G� n U.4 d 4/ Par.Application
Parcel(s) o? '7 1 (tag map#)
For: PrArea 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 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 ff Other: FfG-.-
The attached correspondence contains:
❑Notice of Application ❑Application Materials ❑Meeting Minutes
❑ Record of Decision/Decision Date: ❑ Granted ❑Denied
Denied variances do not need to
IR/Postponed/Tabled(until: QGDW% A 21) he referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
ForAffency Use: Agency Date Stamp—Received:
Log#: LV
Cross References:
*Note referrals submitted via email may require follow-up with paper copies. Revised:W017