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<br />/. <br /> <br />CITY OF Ln. PORTS <br /> <br />ZONING BOARD OF ADJUSTMSNT <br />VARIANCE REQUEST <br /> <br />----------------------------------------------------------------------- <br /> <br />OFFICE USE ONLY: <br /> <br />Fee: $100.00 <br /> <br />Application No.: <br />Date Received: <br />Receipt No.: <br />Regardless of the Board's Decision. <br /> <br />NOTE: This Fee is Non-Refundable <br /> <br />:::::::::~---~-~~~~:;--~J11i~~~;;-~--------------------------- <br />J~- h<,~:~rn;; /f(- :t~d~G PH: L/7/-J?b33 <br /> <br />.4 uddrelSs <br />I am the -t:H'O'IJe:'r of the herein described property. I have authorized <br />to act on my behalf in this matter. <br /> <br />Owner*: <br /> <br />B,.) <br />;I::r-dl - <br /> <br />//~Y7uV~ <br />~ Name <br />$/V' ~ 7040 <br />Address <br /> <br />PH: ~7/-;A79~ <br /> <br />, <br /> <br />I am requesting a variance to Sect. <br />Ordinance No. 15~1. I am requesting <br />at .;r:.. ~ ;:;:...( - ?S' #' /L/S p-__~ ~ <br />Street Address <br /> <br />7 ? CJ-o of the Ci ty Zoning <br />this var)ance foz property located <br />~~ :$':. ,g r r-,A ~ ~.4 .- <br />Legal Description <br /> <br />( ) Site Plan ( ) Minor Development Site Plan <br />( ) Major Development Site Plan ( ) General Plan <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 owner, he <br />on the Owner's behalf. <br />~::J. ~ -1 A <br />v..::.... ~ , <br />Date <br /> <br /> <br />,t 0 act <br /> <br />,.- <br /> <br />----------------------------------------------------------------------- <br /> <br />OFFICE USE ONLY <br /> <br />Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) <br /> <br />Date transmitted to the Board of Adjustments: <br /> <br />Meeting Date: <br /> <br />Applicant Notified of Date: <br /> <br />Notice to surrounding property owners - Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Board Decision mailed to Applicant/Owner: <br />