APA Referral AV 19-2022 (Mann) 5.25.22Town. 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
orfax to: (518) 891-3938 or email* to: LocalGovernmentoapa.ny.gov
From: «n Title: ;Toni•fir Date Sent.
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s):�2�4- J�aAne. /V(ct,-.ri Par. Application #: (( I `4 -
Parcel(s) a&'C-' 1 � . �P- (tax map #)
For: E Area Variance
Local Zonine District(s):
The variance involves (check all that apply):
❑ Use Variance ❑ Septic Variance
APA Land Use Area(s): ❑ Unknown
❑ Hamlet ❑ Moderate Intensity Use ❑ Low Intensity Use
❑ Rural Use ❑ Resource Management ❑ Industrial Use
❑ Shoreline Setback ❑ Density ❑ Front/Rear/Side/Road Setbacks
❑ Shoreline Lot Width ❑ Lot Size LYRoad Frontage
❑ Dock/Boathouse ❑ Structure Height - ❑ Maximum Lot Coverage
❑ - Other Shoreline Requirements CY Other:,5 f ,-~,e ur locaAra-k.
The attached correspondence contains:
C'Notice of Application B A' pplication Materials U91keeting Minutes
❑ Record of Decision / Decision Date:
[TPostponed/Tabled (until:
❑ Granted ❑ Denied
Denied variances do not need to
he referred to the Agency
Thank you for your assistance in helping to keep the variance decision record complete.
ForAFency Use:
Log #: LV -
Cross References:
Agency Date Stamp — Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 8/2017