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~, ~ • ~ CITY OF LA PORTS • <br />ZONING BOARD OF ADJUSTf~9Ef1T <br />SPECIAL EXCEPTION REQUEST ~~7` <br />---------------------------~SG,_t~ ---------APPlication f1o..-~~- ~~_ <br />• OFFICE USE Of~ILY: Fee: $'t0~'8$- Date Received: aZ-/lo <br />Receipt No.: ~/ylo <br />tdOTE: This Fee is flop-Refundable Regardless of the Board's Decision. <br />------------------------------------------------------------------------ <br />App 1 i c a n t : J ~ ~~ ~-J ~- ~ ~ S ~~rLdi ~~ ~~'11,~ ~ ~iz- <br />Name <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: ~~_"Jr~G/CC,~ <br />PJame <br />Address <br />I am reouesting a Special Exception to Sect. //6 v ~,~v of the City <br />Zoning Ordinance No. 1501. I am requesting this Special Exception for <br />property located at ~~v/ ~~~rm~--~T 5~=~ f-~i i -~~ ~~- <br />Address Legal Description <br />• (t~'Site Plan ( ) Minor Development Site Plan <br />( ) Major Development Site Plan ( ) General Plan <br />A Site Plan of the property is attached. Also, I have listed the <br />information reo,uested below on the foll-owing 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. <br />~ If applicant is NOT the owner, he must provide Authorization to act <br />on the Owner's behalf. <br />~.,,5,~ <br />r~- <br />Date ~.~Appl c~'s Signature <br />----------------------------------------------------------------------- <br />OFFICE USE 0?1LY <br />Site Plan and Authorization (if applicable) attached? Yes ( ) A?o ( ) <br />Date transmitted to the Board of Adjustments: <br />Meeting Date: Applicant A?otified of Date: <br />• Board's Decision: Approved ( ) Denied ( ) <br />Notice of Board Decision mailed to Applicant/Owner: <br />