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<br />-;:':"-H <br /> <br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br />Application No.: Si:.oq,oo;t. <br />OFFICE USE ONLY: Fee: $150.00 Date Received: ... S"o&J <br />Receipt No.: I? <br />Note: This Fee is Non-Refundable Regardless of the Board's Decision <br /> <br />Applicant: <br /> <br />l)t? t-t- ;' e <br />, <br /> <br />kAN/N'sk/ <br />Name <br /> <br /> <br />_~ ?.. 5- ~ Cf\1(Yh \ \ ~~ <br />Address <br /> <br />PH:tZA{') ~1UD/~g <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"': '\)tlt+'1 f' KJ\t--\ i NS lC t <br />Name <br /> <br />.s 2~ (~ C-hrrc r / PH: (2-8 1) If 7/-5 tJ 1fT <br /> <br />Address <br /> <br />I am requesting a Special Exception to Sect. <br />ofthe Code of Ordinance. <br />I am requesting this Special Exception for property located at <br /> <br />; -/91 of the City Zoning regulations Chapter 106 <br /> <br />3 2.S ~ (UA-YYO \ ~ <br />Street Address <br /> <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 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 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 act on the Owner's behalf. <br /> <br />Date <br /> <br />Applicant's Signature <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 />