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CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />VARIANCE REQUEST <br />Application No.: ft3— .3 0y�19 <br />OFFICE USE ONLY; Fee: $I50.00 Date Received; 10-1r 13 <br />Receipt No.; _ i v�Q <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />Applicant: � <br />Name <br />Ad ess 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 />lam requesting a variance to Sect. of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at <br />FA <br />Legal Description <br />Site Plan (} Minor Development 5rte rian <br />( } Major Development Site Plan, () 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 Ibis request, <br />1plicant is NOT the owner, he must provide Authorizatio o act on the vner's half. <br />rh <br />Date Of <br />' 'nature <br />Applicants Signature <br />eIlse Oilly <br />Site PIan 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 sua•rounding property owners- Date: <br />Board's Decision; Approved () Denied () <br />Notice of Boards Decision mailed to Applicant/Owner: <br />