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• CITY OF LA PORTE0 <br />RECEIVE® <br />ZONING BOARD OF ADJUSTMENT IN! EC ! 1 NS <br />SPECIAL EXCEPTION REQUEST- _ <br />Itl <br />------------------------------------------------------- - - --- <br />Application No.: ! 0 <br />OFFICE_USE_ONLY: Fee._; ,$50.00 Date Received: g <br />-- Receipt No.. _ sin - <br />NOT <br />E: This Fee is Non -Refundable Regardless of the Board's Decision. <br />---------------------------L-�------------------------------------•--------- <br />Applicant: C�W�'rG_t�!�'� <br />Name 7 <br />S02a 14..P_Q4- U 490M P H : In <br />Address <br />I am the owner of the herein described property. I have authorized <br />to act on my behalf in this matter. <br />Owner*. ------- ------ --- ------------ <br />Name <br />PH: <br />Address <br />I am requesting a Special Exception to Sect. '-�2_ of the City <br />Zoning Ordinance No. 1501. I am requesting this Special Exception for <br />property located at •_� �' ._._.____- _�� l 1Z 2 I' ka A of U CH <br />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 I 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 a jt pr vide Aut orization to act <br />on the Owner's behalf. <br />Date Applic 's Signature <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: Applicant Notified of Date: <br />Board's Decision: Approved ( ) Denied ( ) <br />Notice of Board Decision mailed to Applicant/Owner: <br />