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<br />OFFICE USE ONLY: <br /> <br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br />Application No.: 5t= 10 -OQ r <br />Date Received: /1...-/ rq-Oq <br />Receipt No.: m:;.. J <br />This Fee is Non-Refundable Regardless ofthe Board's Decision <br /> <br />/fW <br />~ <br /> <br />Fee: $150.00 <br /> <br />Note: <br /> <br />Applicant: <br /> <br />8At'~A-~ JI~Me5 /N~ <br />Name <br /> <br />C!k, C.ll#dJ.t!~ t1J1NJ€12 S <br />, <br /> <br />/~Pt '5. /'tl/~~d J'cJlJfUtJ ad. <br />Address <br />r/ltl.'l~Sl.JtRM 17. ??>'Y, <br />I am the owner of the herein described property. <br />to act on my behalf in this matter. <br /> <br />B. ",. <br />'LIJ D <br /> <br />PH: 1?1')"?~ 1'0 '1 t!~Ll <br />J t"1t.C(S' tfll./~:r )(10/ e"":I<:'~c.'f" <br /> <br />I have authorized L7/,1~u=f ~~,tf <br /> <br />Owner" : <br /> <br />I.? ;f';4rff'7 H~,M(."-r <JIV e. <br />Name <br /> <br />S' A AA<.'; <br />Address <br /> <br />PH: <br /> <br />I am req uesting a Special Exception to Sect. <br />ofthe Code of Ordinance. <br />I am requesting this Special Exception for property located at <br /> <br />ofthe City Zoning regulations Chapter 106 <br /> <br />J.-{) T ) J.f /.i /, 1< / 9 <br /> <br />tf ? r~I1IZLe-, r /)-i/t.T' <br />Street Address <br />5 '11.. t-'..-hv AlV1Cu r/l2SJ S't.>l3lJlv/$ /tnV Sr'C (;> <br />Legal Description <br /> <br />Q9 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 />.. If applicant is NOT the owner, he must provide Authorization to act on the Owner's behalf. <br /> <br />/~- '9 -C' '1 <br />Date <br /> <br />~d/~~ <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 />