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,. -. • CITY OF LA cnRTE' <br />ZOPlI~lG~ BOARD OF ADJUSTMENT <br />VART_ANCE REQUEST <br />--------------------------------------------4oolication Alp--- 15 - ~ L~- <br />OFFICE USE OP1LY: fee: 5100.00 Date Received: _ -J.~`^ <br />Receipt No.: O .3 <br />MOTE: This Fee is nlon-Refundable Regardless of the Board's Decision. <br />----------------------------------------------------------------------- <br />Applicant : ,~az ~l S LD~V S T/eGCC~D/(.~ <br />Name ~~P~~L[)~ <br />/11 ~ <br />Address <br />I am the owner of the herein described property. <br />~(jLL1~.L'n~uS~GC~'Tlot~ to act on my behalf <br />Owner* : ~~~ e ~ l~~-l~x~~ <br />Name <br />~. !~ ~ . ()l APL{ l.c )!~i ,~,L')VGIC <br />Address <br />I am requesting a <br />Ordinance No. 1501 <br />a t I Zla ~t`~, <br />variance to Sect. of <br />I am requesting this variance fo <br />P H : `~ ~~'~o~ ~ ~ <br />I have authorized <br />in this matter. <br />PH : ~17~-Z.gj <br />the City Zoning <br />property located <br />Street Address Legal Description <br />( Site Plan ( ) Minor Development Site Plan <br />( ) Major Development Site Plan ( ) general Plan <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 r 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 Aut ri at'o to et <br />on the Owner's behalf. <br />/-~~i~ <br />Date Applicant's ignature <br />OFFICE USE ONLY <br />Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) <br />Date transmitted to the Board of Adjustments: <br />Meeting Date: <br />Applicant Notified of Date: <br />1?otice to surrounding property owners - Date: <br />Board's Decision: Approved ( ) Denied ( ) <br />Notice of Board Decision mailed to Applicant/Ocaner: <br />