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CITY OF LA PORTS <br />ZONING BOARD OF ADJUSTATEqNT <br />VARIANCE REQUEST <br />Application No.. ! - /9' 4(Y,9Od <br />OFFICE USE ONLY. Fee. $150.00 Date Received: //--0 9 �,,? <br />- Receipt No.: � aj 03 <br />Note: This Fee is lion -Refundable Regardless of the Board's Decision <br />Applicant: I0� C�� � � �►`f � i� I'[� t� ��� <br />Name <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*: <br />Name <br />Phone <br />Address IPhone <br />I am requesting a variance to Sect. JQj,— 7 of the City Zoning regulations Chapter 106 oftbLe <br />Code of Ordinance. <br />I am requesting this variance for property located at 1 QQ- <br />Street Address <br />-do`s- oos -()OIt <br />Description <br />{) Site Plaa () Minor Development Site Plan <br />() M'ajor Development Site Plan () General Plan <br />A Sit&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 Tam making this request. <br />If applicant is NOT the owner, he must provide Authorization to act on the Owner's behalf, <br />date <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: <br />Applicant Notified. of Date: <br />Notice to surrounding property owners- Date: <br />licanis <br />13, j 4 <br />Board's Decision: Approved () Denied () <br />Notice of Boards Decision mailed to Applicant/Owner: - <br />