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® CITY OF LA PORTS r <br /> ZONING BOARD OF ADJUSTMENT <br /> SPECIAL EXCEPTION REQUEST <br />----------- ------------------------ ---------Application No.. ~ - GL~~ <br />OFFICE USE ONLY: e~ei 50.00 Date Receive d: ~^/-/ <br /> Receipt No.: U(r-y yoCn <br />NOTE: This <br />----------- Fee is Non-Refundable Regardless of the Boar <br />------------------------------ <br />-- <br />----------- d's <br />---- Decision. <br />----------- <br />Applicant. ~, <br />,~ <br />~ .i7a ~.N ~ ~', ,~.- <br /> (~ tdame <br />I lV ~ ~ J ~ t~} ~i,C1 ~y°~~ <br />P H : ~~~ <br />Ci- ~ ~ ~ y <br /> Address <br />I am th e owner of the herein de scribed property. I have authorized <br /> to act on my behalf in this matter. <br />Owner: <br /> ldame <br /> PH: <br /> Address <br />(~ Site Plan Minor Development Site Plan <br />( ) Major DevelopmeSite Plan ( ) General Plan <br />I am reouesting a Special Exception <br />Zoning Ordinance No. 1501. I am.re~q <br />property located at L_n ~ '`~ ~ 5 C <br />Address <br />_ _ of the City <br />pecial Exception for <br />Legal Description <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 making this request. <br />* If applicant is NOT the owner, he must provide Authorization to act <br />on the Owner's behalf. <br />Date App 'can s Signature <br />----------------------------------------------------------------------- <br />OFFICE USE ONLY <br />Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) <br />to Sect. _, <br />esting this <br />Date transmitted to the Board of Adjustments: <br />n <br />U <br />Meeting Date: <br />Applicant Notified of Date: <br />Board's Decision: Approved ( ) Denied ( ) <br />Notice of Board Decision mailed to Applicant/Owner: _ <br />