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CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />VARTA.NCE REQUEST <br />Application No.: <br />OFFICE USE ONLY: Fee: $150.00 Date Received: —023 13 <br />Receipt No.: <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />Applicant: M� C� <br />Name <br />. ? 4 7P s � ccC e. L� P ��e,��X -�t--asrg,--09 <br />Address 571 Phone <br />I am the owner of the herein described property. I have authorized <br />to act on my behalf in this matter. <br />Owner*: <br />Name <br />Address <br />Phone <br />I am requesting a variance to Sect. of the City Zoning regulations Chapter 106 of the <br />Cade of Ordinance. <br />KA <br />lam requesting this variance for property located at ` ���ti't5�'11.4 <br />Street Address <br />av NJ-, 7 A t o oel-`ant- Sc- -- V [cor4'i <br />Legal Description <br />{•} Site Plan (} Minor Development Site Plan <br />{ ) Major Development Site PIan (} 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 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.' ;> r <br />if applicant is NOT the owner, lie must provide Authorization to act on the Owner's behalf. <br />Office Use Only <br />Site Plan and Autlorization (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 />Board's Decision: Approved O Denied () <br />Notice of Boards Decision mailed to Applicant/Owner: - <br />