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<br />-- CITY OF LA PORTE <br />ZONL ,G BOARD OF ADJUSTMEN': <br />SPECIAL EXCEPTION 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 /> <br />'-::5 - 00 I <br />. <br />3- 1/- os <br />7! 079 <br /> <br />Applicant: <br /> <br />(Y) \ \.l., e. L 0 t'\~ -t C\.. ~" <br />Nam <br />~30L \JoJ\ejbrooK <br />Address <br /> <br />PH: W \ - 4lo-Q(u33 <br /> <br />I am the owner of the herein described property. I have authorized <br />to act. on my behalf in this matter. <br /> <br />('t\ i \-Ze.. lo (\j -'cO:I y) <br /> <br />Name <br /> <br />Owner*: <br /> <br />PH: <br /> <br />Address <br /> <br />I am requesting a Special Exception to Sect. of the City Zoning regulations Chapter 106 <br />of the Code of Ordinance. t" <br />I am requesting this Special Exception for property located at /(Q02- We. S mOt. f ('\ <br />Street Address <br />()~ l,4Vo(te... <br /> <br />Lo+ / 1- ~O <br /> <br />6\OG~111 ToeDy"\ <br />Legal Description <br /> <br />( ) Site Plan <br />( ) Major Development Site Plan <br /> <br />(1-)'Minor Development Site Plan <br />( ) General Plan <br /> <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! am seeking (setbacks, lot coverage, etc.). <br />c) The grounds upon which I am making this request. <br />· If applicant is NOT the ~wner. he mnst provide AnthOriz. atio~n to act of the. ~ehalf. <br /> <br />3h1/DS ~~ v~?0'41 <br />ate App~c~'Iit's Signature <br />Office Use Only <br /> <br />Site Plan and Authorization (if applicable) attached? Yes () No () <br /> <br />Date transmitted to the Board of Adjustments: <br /> <br />Meeting Date: <br /> <br />Applicant Notified of Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Boards Decision mailed to Applicant/Owner: <br />