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'' ._.;~. ~ ITY OF LA PORTE <br />ZON~IIQG BOARD OF ADJUSTMENT <br />VARIANCE REQUEST <br />Application No.: - <br />OFFICE USE ONLY: Fee: $150.00 ~ Date Received: ~[,j.-~~~ <br />Receipt No.: I f '`.~_ <br />Note: This Fee is Non-Refundable Regardless of the Board's Decision . <br />Applicant: ~C~ ~ f~lM ~C7WC"'~_ <br />Name <br />Address ~ Phone <br />I am the owner of the herein clescribed property. I have authorized <br />to act on my behalf in this matter. <br />Owner*: <br />Name <br />Address <br />Phone <br />I am requcsting 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 ~ 7 DU ~.0~ ~ G <br />.Street Address <br />t.Z.3 ~t,aeYa <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 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 Owrier's behalf. <br />. 3 d~ ~ ~ m~ <br />ate 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: <br />Applicant Notified of Date: <br />Notice to~urrounding property owners- Date: ~ . <br />Board's Decision: Approved (~) Denied ( ) <br />Notice ~of Boards Decision walled to Applicant/Owner: <br />