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<br />" <br /> <br />CITY OF LA PORTE <br /> <br />ZONING BOARD OF ApJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br /> <br />--------------------------------~----------------------------~-------- <br /> <br />Application No.: 5e1~-: ()~L <br />OFFI~i:_.JL$~__9JH..J: .f)~~;___._$_5_~.OO:, Date Received: ___1.1-;;#1____ <br />. Receipt No.: ___f2fiz__ ~_ <br />NOT&: This Fee is Non-Refundabl~ Regardless of the Board's Decision. <br /> <br />------------------------------------------------------.__.- -.-.- -........ ..~....----- <br /> <br />Applicant: <br /> <br />!JILl --cO ~'SS "LL ()Jr I. - <br />.JfJLLtl..._J~-'\.._ _ _ _1t'-'_ _ __ _(~_ ____ _JS_._~_l:l.fr:.J:..Q.~V <br />Name <br />3':) - C 1'.) d <br />_._.iJ::.. Lq_____AJ.1L~A- <br />Address <br /> <br />PH: <br /> <br />. 9 . <br />S:2---~/9 <br /> <br />I am the owner of the herein described property. I have authorized <br />__._______________.___.____.__________. to act on my behalf in this matter. <br /> <br />Owne r*: _U!.I1J::.._UJ1..._._____./i.f2-J:.s._C!....I..._._Jf3_'--lJf_!-::._~O\V <br />Name <br /> <br />PH: <br /> <br />Address <br />I am requesting a Special Exception to Sect. J J - ~ a.-S.- of the <br />~~~~~~t~r~~~:~~~ :~. 1~; i_9_~C~~_A.~~~.:.::;t~~__SP:~~~~__~_~_~.ePt ion <br /> <br />Address Legal Description <br /> <br />City <br />for <br /> <br />( ) Site Plan ( ) Minor Development Site Plan <br />( ) Major Development Site Plan ( ) General Plan <br /> <br />-.----.-.-.-.-.-.-..-....--...-.... ..--,--_... ..'... - _._.-". - - - - ---.-.-.-.....--.--.-.-..--.-.-.-.- _._._~_._.~_.._._----_._._..-----_._. <br /> <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 /> <br />* If applicant is NOT the <br />on the Owner's behalf. <br /> <br />$J-t~ <br /> <br />owner, he m~ provide Authorization to act <br /> <br />-~~dl;f2~~ ---- <br /> <br />Applicant's Signature <br /> <br />------------------------.----------------------------------------------- <br /> <br />OFFICE USE ONLY <br /> <br />Site Plan and Authorization (if applicable) attached? Yes ( ) <br /> <br />No ( ) <br /> <br />Date transmitted to the Board of Adjustments: <br />Meeting Date: ~).L}I:tL-- <br /> <br />Applicant Notified of Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Board Decision mailed to Applicant/Owner: <br />