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CITY OF Lk PORTE <br />ZONTIN BOARD OF A-DJUSTM-ENT <br />Address Phone <br />I am the owner of the herein clescribed property. I have authorized <br />to act on my behalf in this matter. <br />e <br />Owner* <br />Name <br />7 �SI I �14en <br />-Address Phone <br />I am requesting a variance to Sect. o f th city Zoning regulations Chapter 106 of the <br />Code of Ordinance. ---- (A y (� n S-� <br />I am rcqUCStlDg this variance for property located at <br />St eet Address <br />Legal Description <br />Site Plan Minor Development Site Plan <br />M . ajor Development Site Plan General Plan <br />A Site Plan of the property i a tt ac h e d. Al I liave listed the information requested beloiv on the <br />following pages of this form. <br />a ) All f concerning 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 malting this request. <br />If applicant is NOT the owner, he must proAde Authorization to act on the Owner's behalf, <br />J <br />Date Applicant �Si2n�atUre <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 oivners® Date' <br />Board's Decision: Approved () Denied ( ) <br />Notice of Boards Decision mailed to Appllcant/OWner: - <br />