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., .~. ~ CITY OF LA PORTE • ZONING BOARD OF ADJUSTMENT ' SPECIAL EXCEPTION REQUEST• -------------~-------------------------------Application-No..~ ~--•---`--- OFFTCE-USE_-ONLY: Fee.~._._.$~.O~OQ Date Received: ___._...._.___....__._._. Receipt N o .. _ ...___._~__ NOTE: This Fee is Non-Refundable Regardless of the Board's~Decision. Applicant: ____._.._..-..._._._...._....-.-•__-_ Name PH: Address I am the owner of the herein described property. I have authorized __._._._..___._.____._.___.__._._._._...._.____.___._._.. to act on my behalf in this matter. Owners : ~_._._.____..__._.. _...._._----.---•----_.__._.__.___.__-•-_-----•_-_-. - Name -•-----.----_...._._.W.~_.-._.._ _.._._.__....._.__....___._._._._._._._._._.._..-.-_-•_-• PH . ..._~__._._. Address I am requesting a Special Exception to Sect. ~.__ of the City Zoning Ordinance No. 1501. I am requesting this Special Exception for p r o p e r t y l o c a t e d a t __.___.____~__._. _._._._.__._._._.___._-___ _~.___.__----.._-- Address _ Legal Description ( ) Site Plan ( ) Minor Development Site Plan ( ) Major Development Site Plan ( ) General Plan A Site Plan of the property is attached. Also, I have listed the information requested below on the following pages of this form. a) All facts concerning the matter that has led up to this request. b) The type of relief I am seeking (setbacks, lot coverage, etc.). c) The grounds upon which I an, making this request. ~ If applicant is NOT the owner, he must provide Authorization to act on the Owner's behalf. Date Applicant's Signature ' OFFICE USE ONLY Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) Date transmitted to the Board of Adjustments: __.__._._.~.___.-_..._._._._. Meeting Date: _._._._._._._.___. Applicant Notified of Date: _._._......_.__...._._..._. • Board's Decision: Approved ( ) Denied ( ) . Notice of Board Decision mailed to Applicant/Owner: _._.~._...._._._._.__._..___