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CITY OF LA PORTE <br /> ZONING BOARD OF ADJUSTMENT <br /> VARIANCE REQUEST <br /> Application No.: //- g 3 O C c'i o <br /> OFFICE USE ONLY: Fee: $150.00 Date Received: 3 — 3/-0' <br /> Receipt No.: 7 if J L/ <br /> Note: This Fee is Non - Refundable Regardless of the Board's Decision <br /> Applicant: e h Ctt e r y <br /> Name <br /> /08011 /1 esqt-is tr Dr, 8l �1 �5 Zy 79 <br /> Address Phone <br /> I am the owner of the herein described property. I have authorized <br /> to act on my behalf in this matter. <br /> Owner *: S jn, e <br /> Name <br /> Address Phone <br /> I am requesting a variance to Sect. it 6-93 3, 19 of the City Zoning regulations Chapter 106 of the <br /> Code of Ordinance. <br /> I am requesting this variance for property located at /0 &.1 M <br /> Se 1.4, -f Dr, <br /> Street Address <br /> Lo 24 Black I2 F01 Y hi %drtx /r`5 r; . lei 2 <br /> Legal Description <br /> (.) "Site Plan ( ) Minor Development Site Plan <br /> () Major Development Site Plan ( ) General Plan <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 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 on the Owner's behalf. <br /> 3 l r <br /> /m LA > - <br /> Date Applicant's Signature <br /> Office Use Only <br /> Site Plan and Authorization (if applicable) attached? Yes () No ( ) <br /> Date transmitted to the Board of Adjustments: <br /> Meeting Date: Applicant Notified of Date: <br /> Notice to surrounding property owners- Date: <br /> Board's Decision: Approved () Denied ( ) <br /> Notice of Boards Decision mailed to Applicant /Owner: <br />