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r. ~ ~ <br />CITY OF LA PORTS • <br />' ZONING BOAP,D OF ADJUST~9ENT <br /> SPECIAL EXCEPTION REQUEST <br />• --------------- -------- --- ~.SG'~~ ---------APPlication P1o.. -~~ _-~Q~ - <br />OFFICE USE 0~•1LY : Fee : $8- Date Receive d <br /> Receipt No.: <br />NOTE: This Fee <br />- is P1on-Refundable Regardless of the Boar <br />---- <br />--------------- <br />-- <br />---- <br />- d's <br />---- Decision. <br />----------- <br />-------------- - <br />J <br />~~~' -- <br />------------ <br />~Ti"'~~`- <br />Applicant: / <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: <br /> Name <br /> PH. <br /> Address <br />I am requesting a Special Exception to Sect. /L GU.~Sv13 ,8 of the City <br />Zoning Ordinance i`lo. 1501. I am requesting this Special Exception for <br />property located at ZU~ /V, ~F LoTs /-/y ;g-~,.,a <br />Address Legal Description <br />(~1 Site Plan ( ) Minor Development Site Plan <br />i ( ) Major Development Site Plan ( ) General Plan <br />A Site Plan of the property is attached. Also, I have listed the <br />information requested below on the 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. <br />~ If applicant is NOT the owner, he m st e Authoriz to act <br />on the Owner's behalf. <br />S-3/-8~ <br />Date Ap icant's Signature <br />----------------------------------------------------------------------- <br />OFFICE USE OP7LY <br />Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) <br />Date transmitted to the Board of Adjustments: <br />Meeting Date: Applicant Notified of Date: <br />• Board's Decision: Approved ( ) Denied ( ) <br />Notice of Board Decision mailed to Applicant/Owner: <br />