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<br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUS <br />SPECIAL EXCEPTION REQ <br />Application N <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 />\\\- <br /> <br />Applicant: <br /> <br />Y:,r i'l r' \! 1" 0\.1 \/11 {"J . <br />\ \ l 1...\ \ LAx _ t /~ I U L-'l, <br />Name <br />\\' \ ~ ,,~.~ '0 '\ \ <br />lJ --..l !) t\), \. '~ ~ <br />Address <br /> <br />Pr~~ l"3>. ss:>- D~95 C.U\ <br /> <br />Lr r)U\4/ <br />,AI \, \. <br />\ <br /> <br />PH: 9\~\-lrl\- Q'11D <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.l9.1- ofthe City Zoning regulations Chapter 106 <br />of the Code of Ordinance. , I.., 1\7 'i\ ''\ D \\ l <br />I am requesting this Special Exception for property located at II') \) I V 'I . -.) \ <br />--=Ii' C' '3 \ \ ./\ 3 ,\ P ,i . tA 11 fli ' i\ \' .,\\~tt~t Ad,d\f~sL I ('J-S <br />L,,~ '- n ___) T ~ I G I (, \) U J T(, ~. Lei \ v L <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 />It If applicant is NOT the owner, he must provide Authorizat' n to act on <br /> <br />/bl7JO -Oy \ <br />Date <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 />