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CITY OF LA PORTE <br />~G BOARD OF ADJUSTME~ <br />VARIANCE REQUEST <br />Application No.: ~ 7 ^ f~0 <br />OFFICE USE ONLY: Fee: $100.00 Date Received: ' <br />. Receipt No.: <br />Note: This Fee is Non-Refundable Regardless of the Board's Decision. <br />Applicant: ~~.ntiw~ (`~ooz.~ ~ . <br />Name <br />lls~o`I W~wow~~~~ ~. 2~t-'i1'D''~S°I <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 />I am requesting a variance to Sect. lfl'b-'l'-11 of the City Zoning Ordinance No.~ 1501. <br />I am requesting this variance for property located at 1~00'l l~ 1 us~vJ~1+~ ~ ~'i . <br />LaT ~ W iLLOv`1~(1 t~ ~ Street Address <br />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 information requested below <br />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 quest. <br />* If applicant i~ NOT the owner, he must provide orization to act on the Owner's <br />behalf. <br />Ot0 ~ ( 2 <br />Date <br />Applicant'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 />Notice to surrounding property owners -Date: <br />Board's Decision: Approved () Denied ( ) <br />Notice of Board Decision mailed to Applicantl0wner: <br />