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<br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br /> <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 /> <br />Applicant: <br /> <br />/7z..1?7.J <br /> <br />w:,sfePrRe/J <br />Name <br /> <br />1: 0 . 80 X <br /> <br />& ICJ j~f <br /> <br />Address / / <br /> <br />PH: .1RI-'I7/--5'525 <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 />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. /11 <br />I am requesting this Special Exception for property located at h:? 6 . /3 k?~J4 D WI If \/ <br />f Street Address / <br />2 s-- Lb'- .:J 7- .2 f f3r-. \t: -5.~ 7 To L fJ <br />Legal Description <br />/' <br />(J(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 applicant is N~ the owner, he must provide Anthorization to act on the zer's behalf. <br /> <br />i z1 /01 d~L ~~ <br /> <br />Date App'l?cant's Signature <br />Office Use Only <br /> <br />L/- <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 />