APA Referral AV 38-2022 (West) 7.20.22Town. 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 Pai*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: LocalGovernment@apa.ny.gov j
From: L.6AA' G Date Sent: !
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): -B re, b % + f O-t"J e% GUZ64- Var. Application #: AV � 0-- �a
Parcel(s) RQ (, . I S - I ( `7 (tax map #)
For: 1"rea Variance
Local Zoning- D1istriict(s):
1/lJ /\
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
❑ Road Frontage
❑
Dock/Boathouse
❑ Structure Height
❑ Maximum Lot Coverage
❑
- Other Shoreline Requirements
D"'Other: VJ e,�,j
je
The attached correspondence contains:
CNotice of Application [Application Materials LIeeting Minutes
❑ Record of Decision / Decision Date:
2 Postponed/Tabled (until: I )
❑ 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.
For Affency Use:
Log #: LV
Cross References:
Agency Date Stamp - Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 8/2017