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, `/a Local Government Services, PO Box 99, Ray Brook, NY 12977
orfax to: (518) 891-3938 or email` to: LocalGovernment@apa.ny.gov
From: eta t Gt -0 'no c t.14 Title:. 20,111A j- Date Sent: 1 l 130
The Adirondack Park Agency is hereby notified of the receipt of a variance referral record.
Applicant(s): scnS Ara /-b ilk L- Van Application #: AV 6-3 --Ob �
Parcel(s) 0I, % 3 ' - ') (tax map #)
For: QArea Variance
Local Zoniniz District(s):
v�
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
Er
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
®' Other:
The attached correspondence contains:
ClNotice of Application [t-Application Materials
❑ Record of Decision / Decision Date:
P`Postponed/Tabled (until:
❑"Meeting Minutes
❑ 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.
ForAyency Use:
Log #: LV ..
Cross References:
Agency Date Stamp - Received:
*Note referrals submitted via email may require follow-up with paper copies. Revised: 812017