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CIT Y OF LA POR'T'E <br />ZONING BOARD OF ADJUSTMENT <br />SPEC L4,L EXCEP'T`ION REQUEST <br />Application No.: 11- W100000 / <br />OIzFICE USE ONLY Fee $150.00 Date Received: 3-30-P <br />Receipt No.: c S �h�� <br />Note: This Fee is Non- Refundable Regardless of the Board's Decision <br />Applicant: a_a a YA <br />C-A � JJ Name <br />to o 4 IN . Fit l V M bbl 1 � � C l ,�� PH: p gj- q 70 <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" : ! L, © r to <br />Name <br />CpD ft9. Falrmo/n.r ,-ICwt Pi-I: 20) ~qW 50 in <br />Address <br />I am requesting a Special Exception to Sect, of the City Zoning regulations Chapter 106 <br />of the Code of Ordinance. <br />I aiu requesting this Special Exception for property located at - ��u'1`�1 :!S; I . <br />St ree Address <br />Lc i 11 ~' ! E) l tic « --- rq L� e) r +e- <br />Legal Description <br />( Site Plan () Minor Development Site Plan <br />() Major Development Site Plan (j General PIan <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 concerning the matter that has led up to this request. <br />b) Tire type of relief I am seeking (setbacks, lot coverage, etc.). <br />c) Tile grounds upon which I am making this request. <br />If applicant is NOT the owner, he must provide Authorizati n to act on the w ev behalf. <br />3 A ; 0 1 2 ® 11 <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 />Board's Decision: Approved () Denied ( ) <br />Notice of Boards Decision mailed to Applicant /Owner: _ <br />