Freshwater Wetlands Permit ApplicationUpdated: 03/05/2004
TOWN OF OUEENSBURY
FRESHWATER WETLANDS PERMIT APPLICATION
APPLICATION NO.:
APPLICATION DATE:
This is an Application for a Permit to conduct/cause to conduct a regrilated activity on or
adjacent to a freshwater wetland pursuant to Freshwater Wetlands Protection Law - Local
Law 1, 1976.
TO: Town Clerk of the Town of Queensbury - Please immediately forward this
application to the Planning Board of the Town of Queensbury by way of service upon the
Planning Department of the Town of Queensbury.
TO: Applicant - Please type or print the information required and complete all blanks and
answer all questions. If the information requested is not applicable, please enter N/A. Please
provide the original plus 14 conies of this application with a $100 application fee.
INFORMATION FOR APPLICATION
Applicant:
Name: Brett and Pamela West
Address: 4651 Gulf Shore Blvd N Unit 104
Naples FL 34103
Phone: 203-948-5847
Property Information:
Name of wetland or any body of water/sheam involved:
ACOE Wetland adjacent to Lake George
2. Address of parcel upon which wetland is located and address of parcel(s) upon which
work is proposed.
106 Bay Parkway
5.
Updated: 03/05/2004
Tax Map No. of parcel upon wetland is located and Tax Map No. of parcel upon
which work is proposed: 226.15-1-17
Current zoning of parcel upon
which wetland is
located and current zoning
of parcel
upon which work is proposed:
WR
Waterfront
Residential
Total area of property on which work is proposed: •91 ACreS
6. Total area of wetland: 1,019 SF
7. Dimensions of wetland: Approx. 9 ft x 125 ft
8. Existing uses of wetlands,
0
10.
Adjacent uses withni 400 ft. of wetlands, if any: Residential
State, County, Town property within 500 ft. of wetland:
New York State Warren County, Town of Queensbury
Inforn�ation About the Project:
if any:
Detailed
description of proposed activity: Applicant
proposes
to remove
existinq
residential
structures and construct a new
8,670
SF home on .91
acres.
2. Purpose, character and extent of proposed activity upon or adjacent to wetland:
Residential home
3. On a snap to be submitted with this application, show the area of the freshwater
wetland or adjacent area directly affected with the location of the proposed activity
shown to scale thereon as well.
4. Will the project require any other Federal, State or local permits? No
5. Has work begun on the project? No
6. Approximate starting date of project? September 2022
T Approximate completion date of project? September 2024
Updated: 03/05/2004
About the adjacent property owners:
List the names of the owners of record of lands adjacent to the fieshwater wetland or
adjacent area upon which the project is to be undertaken:
Daniel O'Keefe
Name of claimants of water rights which you have noticed and which relate to any land
within or within 100 ft. of the boundary of the property on which the proposed regulated
activity will be located:
The foregoing information will be reviewed by the agency, and the agency, may if it desires,
request any further information necessary to make a decision.
I hereby affirm under penalty of perjury that the informarion provided herein and all
attachments submitted here�yj�th are true to the best of my knowledge and belief.
Signature:
I hereby author Environmental Design Partnership to act as my agent and represent me
in connec wrth this application on my behalf.