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CITY OF LA PORTE <br /> ZONING BOARD OF ADJUSTMENT <br /> SPECIAL EXCEPTION REQUEST <br /> Application No.: /7—'74 000c00 / <br /> OFFICE USE ONLY: Fee: $150.00 Date Received: 3 - 3o -- <br /> Receipt No.: c,2 __ <br /> Note: This Fee is Non - Refundable Regardless of the Board's Decision <br /> Applicant: . gec` 0. <br /> c' Name <br /> (00 4 11v. Fair mor i 1 2I(1/ PH: g(— 70 - 43 <br /> Address <br /> I am the owner of the herein described property. I have authorized <br /> to act on my behalf in this matter. <br /> Owner *: (11+1 OP L et erte <br /> Name <br /> (OOLI (45 Fair/via/Cr / PH: vZS �7 5c0 CD <br /> Address / <br /> I am requesting a Special Exception to Sect. of the City Zoning regulations Chapter 106 <br /> of the Code of Ordinance. <br /> I am requesting this Special Exception for property located at 1 -- ouy-,h <br /> L 0 11 a 2 , 7 <br /> Stree Address <br /> I 9 L. o r + e <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 Authorizati i n to act on the • w r - " • behalf. <br /> 3/g 0/2 1r • � , <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 /> Board's Decision: Approved () Denied ( ) <br /> Notice of Boards Decision mailed to Applicant /Owner: <br />