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CITY OF LA PORTS <br />. ZONIlVG BOARD OF ADJUSTIVIEEN'T <br />vA~~ANCE REQUEST <br />Application No.: x" Y y"V G ~ <br />OFFICE USE ONLY: ~ Fee: 5100.00 Date Received: ~ ~•?8- <br />Receipt No.: __~?~ bit ~'~. <br />N e: This Fee is Non-Refimdable Regardless of the Board's Decision. <br />Applicant: o ~T' ~ ~0 P~C-~-T~ ES . ~Al C.. - r <br />Name `~~ ? ~d'~-~ 7 tf~' <br />_ ~~ D • ~aX X07. L,t1- G~ ^ X, 7 75~ 1 <br />Address Phone <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 />Address . Phone <br />Iam 1O(a 19~~6 a) ~ ~oc~~-m~ 01^di-~~/2c~5 <br />requesting a variance to Sect. X of the C~7' Eee~g-A ' . 1. <br />I am requesting this variance for property located at tO .Z 9 /V . ~ <br />~O ~' ~ ~ 7 -~1 YUI.. 3 2- . ~ f ~ C ~ ~ ~ S ~ Address <br />~~~ ~~s~ <br />Legal Description ' . <br />()Site Plan ()Minor Development Site Plan <br />()Major Development Site Plan ()General Plaa <br />A Site Plan of the property is attached. Also, I have listed the information requested below <br />on the following pages of this form. <br />a) All fads 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 malting this request. <br />* If applicant is NOT the owner, he mu provide Authorization to act on the Owner's <br />behalf. <br />O 2$ ~ - ~• ~ 0 Vwil~i <br />Date Applicant's Signature <br />Office Use Only <br />Site Plan and Authorization (if applicable) attached? Yes () N/o ( ) <br />Date transmitted to the Board of Adjustments: / ~~ - / q <br />Meeting Date: ~ °~a s/~' 9 Applicant Notified of Date: ~~ 9 <br />Notice to surrounding property owners -Date: <br />Board's Decision: Approved () Denied ( ) <br />Notice of Board Decision mailed to Annlicant/owner: <br />