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CITY OF LA PORTS <br />ZO~G BOARD OF ADJUSTME~ <br />VARIANCE REQUEST <br />Application No.: ~ - OJT <br />OFFICE USE ONLY: Fee: $150.00 Date Received: ~- Off- pL~ <br />Receipt No.: f~ ~ ,y ,g' <br />Note: This Fee is Non-Refundable Regardless of the Board's Decision <br />Applicant: ~~ _ ~;,~~7~F ~ra{~1 - I7r~~rz~~ ~Pr74-~rPS i_~~ <br />Name <br />t aca i Cer•tt~r ~~r~~t <br />Dees- 'mot ~~~-k, j ~x~c> ~t`x`-~ ~i~z ~~t . ~3c~. ~?~S <br />Address Phone <br />I am the owner of the herein described property. I have authorized (?~ ~~ ~,~ch~~y~~ <br />to act on my behalf in this matter. <br />Owner*: ~~ ~ ~ ~i rp7 (,~ ~~~c~ ~ ~ _'_' <br />Name <br />15G I CEr`~t~Y ~ ~s'~t <br />. Address Phone <br />I am requesting a variance to Sect. IDIn •-l~l ~ of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at ('rrr~ f t"~ "~~ ~~~,-~, C-i 5t~.e~. <br />Street Address <br />Legal Description <br />(`~ Site Plan ~) Minor Development Site Plan <br />(k) Major Development Site Plan (~ General Plan . <br />A Site Plan of the property is 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 al;plicant is NOT the owner, he must provide Authorization to act on the Owner's behalf. <br />'`~ ~.. <br />ate _ Applicant's Signature <br />. Office Use Only <br />Site PI:m 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- Do-ite: <br />Board's Decision: Approved () Denied ( ) <br />Notice of I~oards Decision mailed to Applicant/Owner: <br />