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CITY OF LA P ORTE <br />ZONING BOARD OF ADJUSTMENT <br />VAR]ANCE REQUEST <br />Application No.: <br />OFFICE USE ONLY: Fee: $150.00 <br />Date Received:_ <br />- —� <br />/,17 k29- <br />Receipt No.: <br />Note: This Fee is Non -Refundable Regardless of the <br />Board's Decision <br />Applicant:%JAY► �rt! ,/YG�� <br />G ,� <br />G<S,/.� <br />Name <br />C-X�, qJ'/ <br />- # <br />Address <br />Phone <br />v � <br />I am the owner of the herein described property. I have authorized k t"n it .ti+ Z -� <br />to act on my behalf in this matter. <br />Owner*: <br />Name <br />Address Phone <br />I am requesting a variance to Sect. of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at O% G . � <br />t � Street Address <br />-it45 3o-4 &k I J� �txvn �+ �. Ai3S 551 /4 <br />Legal De-scripti6n <br />{) Site Plan <br />( inor Development Site Plan <br />() Major Development Site Plan () General Plan <br />A Site.Plan of time property is attaches[. 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 PWID31yner's behalf. <br />c <br />s-�j 3 <br />Date <br />Office Use Only ` <br />Site Plan and Authorisation (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 />licant's <br />Board's Decision: Approved () Denied () <br />Notice of Boards Decision mailed to Applicant/Owner: <br />