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CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />VARIANCE REQUEST <br />Application No.: II - 4 0 0 r,' 001 <br />OFFICE USE ONLY Fee $150.00 Date Received: 3- 31 , 11 <br />Receipt No.: 7� 1lj <br />Note: This Fee is Non - Refundable Regardless of the Board's Decision <br />Applicant G1._ 1_' c 6t y r y <br />Name <br />1 Mesgwl'fe Dr, <br />Address <br />I am the owner of the herein described property. I have authorized <br />to act on my behalf in this matter. <br />Owner *: -� Ca <br />Name <br />Address <br />Phone <br />I am requesting a variance to Sect. 6 33 3 C / of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I ann requesting this variance for property located at <br />(,)";Site Plan <br />() iMajor Developnnennt Site Plan <br />Legal Des <br />{) Minor Development Site Plan <br />{) General Plan <br />A Site Plan of the property is attached. Also, I have listed the information requested below on the <br />following pages of this form. <br />a) All facts concer the matter that has led up to this request. <br />b) The type of relief I am seeking (setbacks, lot coverage, etc.). <br />c) The grounds upon which I am making this r equest. <br />* If applicant is NOT the owner, lie must provide Authorization to act on the Owner's behalf. <br />3 - - 31- If L� m c "� <br />Date Applicant's Signature <br />Office Use Only <br />Site Plan and Authorization (if applicable) attached? Yes () No ( ) <br />Date transmitted to the Board of Adjustments: <br />Meeting Date: <br />Applicant Notified of Date: <br />Notice to surrounding property owners- Date: <br />Street Address <br />ah-i A - ei Yr'Cj (e <br />Phone <br />Board's Decision: Approved () Denied ( ) <br />Notice of Boards Decision mailed to Applicant/Owner: _ <br />