APATown 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, c/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: GrL(t /.d ►_0 vJrl Title:2p/7 Date Sent: 113
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): L a l-&.-Le CKas5�elellg A .S' (ev a Par. Application #: A V
Parcels)' G,(d, - 1 - `7�. l (tax map #)
For. GB'Area Variance
Local Zoninff District(s):
rc
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
❑ Shoreline Lot Width ❑ Lot Size
❑ Dock/Boathouse ❑ Structure Height
❑ Other Shoreline Requirements ❑ Other:
The attached correspondence contains:
09'T'ront/Rear/Side/Road Setbacks
❑ Road Frontage
❑ Maximum Lot Coverage
RNotice of Application 03'Application Materials ❑ Meeting Minutes
❑ Record of Decision / Decision Date: ❑ Granted ❑ Denied
C►-YPostponed/Tabled (until: i 1 13c, jai )
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.
ForAyency Use:
Log #: LV
Cross References:
Agency Date Stamp — Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 8/2017