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CITY OF LA PORTE' RECEIVED <br />ZONA BOARD' OF ADJUSTMENO JUL 0 6 2004 <br />VARIANCE REQUEST <br />Application No.. <br />OFFICE USE ONLY: Fee: $150.00 Date Received: <br />Receipt No.: <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />Applicant: � FROY <br />Name . <br />291 -1,�71- CS �C1 <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*: rC 0 � l h� <br />Name <br />Address . Phone <br />I am requesting a variance to Sect. of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at <br />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 propertyis attached. Also, I have listed the information requested below on the <br />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 must provide Authorization to act on the Owner's behalf. <br />Date Applicant's Signature <br />Office Use Only <br />Site Plain 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 Boards Decision mailed to Applicant/Owner: <br />