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<br />;;: 1+ bOI - D6(;)0 (jtJ'iS DIOlt <br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTl\1ENT <br />V ARlANCE 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 />V'Oli-DO I <br />j-i(ro<1 <br />'f3>LP~ (p <br /> <br />Applicant: <br /> <br />G \...1..>.-\ ~. 1...\ 12 c........ 'I <br />"- <br />Name <br /> <br />\\ 0\\ <br /> <br />"bOA, "'-~ AQ.~........~ '"""V€'. \-..... ~o ~ \~ <br />\ <br />Ad dress <br /> <br />"'71 3~ J'IS - 09 ,. {, <br />Phone <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 />G u....'-l. <br /> <br />~. ~C1. ",,-, <br />Name <br /> <br />\ \ I,) \\ S Q. ""- ~... Co,-,\-- ~ Vr. <br />Address <br /> <br />l.."" ~.. ..... ~ (. \X <br />I <br /> <br />7 -( 3 - "5 '-tS' - 0 c;. 2. '- <br />Phone <br /> <br />I am requesting a variance to Sect. of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at \\0\\ Sr:\"... S~c.~......~ '""i;><'. "'-~?CJ --\ll.. \x-. <br />Street Address <br /> <br />Legal Description <br /> <br />() Site Plan <br />() Maj or 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 Authorization to act on the Owner's behalf. <br /> <br />Applicant's Signature <br /> <br />Date <br /> <br />Office Use Only <br />Site Phn 2nd 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 />Notice to surrounding property owners- bate: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Boards Decision mailed to Applicant/Owner: <br />