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CITY OF LA PORTS <br />ZONING BOARD OF ADJUSTMENT <br />VARIANCE REQUEST <br />Application No.: _ // - � WJ <br />OFF USE ONLY: Fee: $150. 00 Date Received: <br />Receipt No.; <br />Note: This Fee is Noll- •Refundable Regardless of the Board's Decision <br />Applicant; <br />Na me <br />Address Phone <br />I am the owner of the herein described property. I have authorized r�/ R [L <br />to act on nay behalf in this matter. 3 .- a 6q- 635 <br />Owner *: r.��'r <br />Name <br />Address Phone <br />I am requesting a variance to Sect. T of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance, <br />lam requesting this variance for property located at �t u <br />Street ddress <br />Legal Description <br />() Site Plan <br />() Major Development Site Plan <br />Minor Development Site Plan <br />General Plan <br />A Site flan 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 seeping (setbacks, lot coverage, etc.). <br />c) The grounds upon which I am maldng this request. <br />If applicant is NOT the owner, he must provide Authorization to act on the Owner's behalf. <br />r 111-J l ("� /I— � �, � <br />Date Applica #f'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: <br />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 />