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<br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />V ARlANCE REQUEST <br /> <br />\/l(;~~ 007- <br /> <br />OFFICE USE ONLY: <br /> <br />Application No.: <br />Date Received: <br />Receipt No.: <br />This Fee is Non-Refundable Regardless oftbe Board's Decision <br /> <br />Fee: $150.00 <br /> <br />II" ~ ..{ 0 <br />I r.~j)r5" <br /> <br />Note: <br /> <br />Applicant: <br /> <br />=.J \ rlQ BzJ ~ oe <br />Name <br /> <br />;1~\ 5~ 1.. 1"\ '-t 0 <br /> <br />3~q ~re..<..{ 0Jrcl€.. GLPDv--k.. Te.'lQ~ 1151 ( <=63d.- 4;;1:j 4Gi '0 <br />Address Phone <br />+-16me.. aLi.r-e-seo 'H.p';, ~ Srrvv~c; ~\vt LCL-Pcv-k. '\\f.-1"1S II <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 />Address <br /> <br />Phone <br /> <br />I am requesting a variance to Sect. <br />Code of Ordinance. <br />I am requesting this variance for property located at 3~q ~r~~ Ql r~\-e <br />Street Address <br /> <br />of the City Zoning regulations Chapter 106 ofthe <br /> <br />Lets In''" ~ U <br /> <br />81\(..4 <br /> <br />Se..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 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 tbis request. <br />* rf applkant 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 />Site Pl:1n 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 />Notice to surrounding property owners- Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Boards Decision mailed to Applicant/Owner: <br />