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<br />r--",-~ <br /> <br />c:c <br /> <br />OFFICE USE ONLY: <br /> <br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTl\1ENT <br />SPECIAL EXCEPTION REQUEST <br />Application No.: OCI- 003 <br />Date Received: 1-1 q- Ot <br />Receipt No.: Lf' f) q <br />This Fee is Non-Refundable Regardless of the Board's Decision <br /> <br />j. ;:----.. <br />I. I_'~ <br />i <br /> <br />r-~ <br />ft,.,.-,. ~;-'-i!j <br />I~;.-- .~. ~.< <br />.~ ~ <br />r. ....p 1 b "0'" ~ ~ <br />~t e L uS l.. N .~ <br />fJ-Y <br /> <br />i <br />t i <br /> <br />[II. <br /> <br />Fee: $150.00 <br /> <br />Note: <br /> <br />c::trcr 0 . .J,/-D <br />, Name <br />+A. L?J. 57) <br />--Z:Z~ >. J b ,)vl1ror/et" 7f 77 PH: <br />Address <br /> <br />I am the owner of the herein described property. I have authorized ~...J 7I h. ~ d r <- <br />to act on my behalf in this matter. / ' <br /> <br />Applicant: <br /> <br />Owner'" : <br /> <br />Vt<yc-O , l., If? <br />I Name <br />zzS- ~r/6 t-h h9/f:A -7;'. 7777 r <br />r. , <br />Address _ <br /> <br />PH: L $1 / g-,6 7 ) J '-- ~ <br /> <br />I am req uesting a Special Exception to Sect. <br />of the Code of Ordinance. <br />I am requesting this Special Exception for property located at <br /> <br />of the City Zoning regulations Chapter 106 <br /> <br />~~';7 1/-1/"2- <br />,~ <br /> <br />f3y '/'7'2..- <br />Legal Description <br /> <br />'2- '2.. 5' ;;, ) 7 f-t, <br />Street Address <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 />f-/I-oC; . d/-4_~~ <br />. Date IV/V ~~t'~ignature <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:- _u <br /> <br />--uApplicant 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 />