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<br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br /> <br />--------------------------------------------~~~l~~~~i~~-N~~~~=:-ZO~-- <br /> <br />OFFI~..LJJSf;___O)'t~J: f_~~;___-_$_5_~~OO , Date Received: _.Jp-!:z.1-.9L.__. <br />R e c e i p t No.: _.65flg 'f <br />NOTI: This Fee is Non-Refundable Regardless of the Board's Decision. <br /> <br />---------------------------------------------------------_._._._--_._-~------ <br /> <br />Applicant: <br /> <br />-r~&1-~_~_~~~._ ~~L(.:-__________ <br />~{Q<:eJ31fl..k_Dt1ffi~ ND~~~ ---rY <br />/ <br />Address <br /> <br />PH: ifZ[~L'1t, <br /> <br />I am the owner of the herein described property. I have authorized <br />____._._____._._._________._______u____ to act on my behalf in this matter. <br /> <br />Owner*: <br /> <br />Name <br /> <br />PH: <br /> <br />Address <br /> <br />I am requesting a Special Exception to Sect. of the City <br />Zoning Ordinance No. 1501'..A,~/~m rxquesting this Special Exce t'on for <br />property located at '11"5 O.M.L~1..L_. LtJr./3 r5lk...:i. <br />t? -- . S ~ o.-l Address p .s; ~el~l De~ti n <br />.MJ2t:1L _. EX-. _ V l!&.-Pt 57 fD _ A.M!JJ.$_~~/~ 39_________=1J" f '______ <br /> <br />( ) Site Plan ( ) Minor Development Site Plan <br />( ) Major Development Site Plan ( ) General Plan <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 owner, he <br />on the Owner's behalf. <br /> <br />JO_-lo - q2, <br />Date <br /> <br />m~ provide <br /> <br />~ <br /> <br />Authorization to act <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 /> <br />Meeting Dat-e: <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 /> <br />~-"-"-'------'- - ---..~.- ........_~_...-..-~._-,,--. <br />