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<br />OFFICE USE ONLY: <br /> <br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br />Application No.: ~c. 6 g' - 0 0 I <br />Date Received: 12 / (p <br />Receipt No.: I () :$ 73 '-/ <br />This Fee is Non-Refundable Regardless of the Board's Decision <br /> <br />Fee: $150.00 <br /> <br />Note: <br /> <br />Applicant: <br /> <br />[? j.f dJt t t.~ 5' <br />Name <br /> <br />/}-JlVjk-7i S'. <br /> <br />) "f cPJ'" C, 1~I'C-<-t.Vr.1S-L< rf.!:.lYJ /.Jid tj ZC Z PH: y ? :J;7 ?/.. 4~l.1 <br />Address ;:;2lc~S....,J:.'Ct'''' 'f)., ??S~.;;c <br /> <br />I am the owner of the herein described property. I have authorized t"}N471~C=of ~l':tJU <br />to act on my behalf in this matter. <br /> <br />Owner" : <br /> <br />./34'Y t:.v""" l'hu'Vi. t5- S' ; v-' e . <br />Name <br /> <br />l'tly f r:-JJ-i~~~l7J/?! ,fh~ (Jf.-t)"l) " PH: ;J- y/ e: &.1" y t9;;!S' <br />Address r Q u:- ~~ t..>-fl~ Y).., 7? ~'"1f4 <br /> <br />I am requesting a Special Exception to Sect. of the City Zoning regulations Chapter 106 <br />ofthe Code of Ordinance. <br />I am requesting this Special Exception for property located at <br /> <br />J() F())2It-~S;-, <br /> <br />Street Address <br />/J i- i<.. ) S" k;)- & .s- '-:'i. J/ ~ :1 (:::..+t! H . <br />Legal Description <br /> <br />( ) Minor Development Site Plan <br />() General Plan <br /> <br />Wite Plan <br />( ) Major Development Site Plan <br /> <br />A Site Plan of the property is attached. Also, I have listed the information requested below on the <br />following pages ofthis form. <br />a) All facts concerning the matter that has led up to this request. <br />b) The type ofreliefI 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 on the Owner's be . <br /> <br />0'- 6- "of~ -::?-~. <br /> <br />Date Applicant's Signature <br />Office Use Only <br /> <br /> <br />Site Plan and Authorization (if applicable) attached? Yes 0 No 0 <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 />