Laserfiche WebLink
CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br />Application No.: 1/--W100000 / <br />OIzFICE USE ONLY: Fee: $150.00 Date Received: 3.30 -- it <br />Receipt No.: c �h�� S-R <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />Applicant: Q a YA <br />Name <br />trio 4 W. Fi2! rm'em 1 ��Cl,�� PH: pgj-q iD <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 />p (9 <br />Owner" : ! L, © r to <br />Name <br />CpD ft9. Falrmo/n.r ,-ICwt Pi -I: 20)~qW 50-2in <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`�1y :!S;I . <br />St ree Address <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 ;0 2®I ! <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 />