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CJT'! OF LA FORTE <br />•%CrilDiis BOA~tD GF ADJUSTriEIv~ ~. <br />_ SPECIAL EXCEPTION REQL'EST~ <br />------------------_____----------------------Application i"o.~-(~~-~~?.~' <br />OFFICE ~5,~' OIvL'~. Fee"..___.~~'~-CO Date Received. _•~(-.~c~. _~~~_~ <br />_. _._ L .- .. - RecelpL NO.. ___ ~-.:~ ~-:..,-~ <br />NOTE: This Fee is Dion-Refundablz Regardless of the Board's Decision. <br />Applicant: ~~brd _~.~0~_,~_.~__C`~~,cU~r_~{--~-r'----•--.. <br />Name <br />!~ ... Sr _IC~I N ~4$' _~_L____~ R~ r (~. /x ~ J~r7~ P:-} . 2 J'~`t ~,~ 5 ~-`7 ~ . <br />Address <br />I am the owner of the herein described property. I have authorized <br />-__^--_____-_r________._.-._____--_-•__, to act on my behalf in this matter. <br />owner: ,~-L=~-'.~_-~1s,c_~__.~~'Qwr~(,(_.~-r._•----•-- - <br />~ Name 3/t /~kn+SRS sT,! <br />--/L'~.t~•_r_ i ,, - X ,V775. ~ / PH . ~` ~~f '~ IS~3 <br />Address <br />.. ~~'}3 <br />T~~ <br />I am requesting a Special Exception to Sect. ~~~~`-~•3~~ of the CiL-y <br />Zoning Ordinance No. 1501 I am requesting this Special Exception for <br />property 1 o c a t e d a t .,Zr? ~ ~_.(.Q~ /_[.w 1~.-~-! --_- s /, __-'G ~ ~'• •?E _%1,.~.~-~T~y n~°•rT~ <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 r~.~.st provide Authorization to act <br />on the Owner's behalf. !^ <br />Date ~.~ p icant s Sig <br />OFFICE USE ONLY <br />Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) <br />Date transmitted to the Board of Adjustments : .r.~~_.__.__ <br />Meeting Date: ~ _._._._.____..__ Applicant Notified of Date: __._._._.___...._._.__ <br />Eoard's Decision: Approved ( ) Denied ( ) <br />Notice of Board Decision mailed to Applicant/Gwner: _..._...._...__.__.____ <br />