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<br />'=:ITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />VARlANCE 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 />(l) - tJ 0..3 <br />h~6-0.) <br />(oyJ'<3 <br /> <br />A pplican t: <br /> <br />{' h Jte Is;.} If ~jJc) ~ ~ 71/V I( Ell/ (! ~ <br />Name . I <br />h l50lc. /31-3 /;1I/5l.1 7Z(-:f/ 713~4J-S-:#6tJ <br /> <br />f . <br /> <br />Address Phone <br /> <br />I am the owner oCthe herein described property. I have authorized <br />to act on my behalf in this matter. <br /> <br />Owner*: <br /> <br />Name <br /> <br />Address <br /> <br />Phone <br /> <br />/06-1C/-fJ ;L. <br />I am requesting a variance to Sect./OCt - 791 of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at <br />Au . h / Street Address <br />FER /7//r/t.', 7r>C/ 0U,eL--f.t? y", <br />. Legal Description I <br /> <br />}(Site Plan <br />( ) Major Development Site Plan <br /> <br />( ) 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 a}:plicallt is NOT the owner, he must provide Authorization to act on the Owner's behalf. <br /> <br />6, /:?/q:J &~ ~ -t:~ <>__ <br /> <br />D~e Applicant's Signature <,7e>L <br />Office Use Only <br />Site Phn ~nd Authorization (if applicable) attached? Yes () No () <br /> <br />.:.r:-- <br /> <br />Date transmitted to the Board of Adjustments: <br /> <br />Meetirg Date: <br /> <br />Applicant Notified of Date: <br /> <br />Notice to sunounding property owners- Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Hoards Decision mailed to Applicant/Owner: <br />