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<br />OFFICE USE ONLY: <br /> <br />Application No.: <br /> <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 />Note: <br /> <br />Applicant: <br /> <br />.\\ \) '\M. U\. ~ W \ ')< ('\! ~ \( <br />Name <br /> <br />~(Cl, lj() 'I. '\ ~L\. \ LG\?u r'\-e ,\\ :rt~ ~ 1 <br />Address <br /> <br />PH: L ~L t-YL\- . \ \~ '1 <br /> <br />I am the owner of the herein described property. I have authorized <br />to act on my behalf in this matter. <br /> <br />Owner'" : <br /> <br />Name <br /> <br />PH: <br /> <br />Address <br /> <br />I am req uesting a Special Exception to Sect. \ 0 b~ ~ ~ ~ of the City Zoning regulations Chapter 106 <br />of the Code of Ordinance. <br />I am requesting this Special Exception for property located at 1 a \ ';' l {' -e ,:>ct' V\\- \)~ 'fC <br />Street Add ress <br /> <br />lot <br /> <br />~ <br /> <br />\~ , 0 c.. Y, 1- <br /> <br />C i"'e ') C. (' V\, -\- C; 40 {'--c '> <br />Legal Description <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 in form ation req uested 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 ~owner's behalf. <br /> <br />)~l~-O~ / <br />Date <br /> <br /> <br />Office Use Only <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 />