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<br />OFFICE USE ONLY: <br /> <br />Application No.: <br />Date Received: <br />Receipt No.: <br />This Fee is Non-Refundable Regardless of the Board's Decision <br /> <br />Fee: $150.00 <br /> <br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br />St?- LP - <br />'0 0\ O(p <br />\ <br /> <br /> <br />Note: <br /> <br />Applicant: <br /> <br />n(lnVAC ?Q/V\Ol~ <br />Name , -nc-';l/ . _, <br />LI?2 \"i( W .{), ~-\. LoPQl\( 1Y PH?7'K 1- Llll- LJ?t<: G <br /> <br />Address <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 />Owner*: <br /> <br />Name <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. JJ . I~ '" () \,..l <br />I am requesting this Special Exception for property located at _~ 1 "'g ,\....). r. ~ \ . <br /> <br />'\ Qg ~~ W1 ~,3 U h ~ -311 LJ l (~ D 6~lfft AOllllt)-\$ <br /> <br />Legal Description <br /> <br />PH: <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 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 Authoriza~on to act)}, the Owner'.s-;;?ehalf. <br /> <br />/f)- .1/ ~ ?.tl;J f n ?--t---f' /(or :;$1' . / <br />Date Applicant's Si ature <br /> <br />Office Use Only <br /> <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 />