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CITY OF LAPORTE <br />ZONTNTG ]BOARD OF ADJUSTHENT <br />Application No.: <br />-ZL <br />OFFICE USE ONLY. Fee: $I00 Date Received: <br />Receipt No.: <br />Note: This Feeds Non -Refundable Regardless of the Board's Decision <br />Applicant - <br />I <br />Name <br />1 1) t I —CT1 <br />Address authorized Phone <br />I am the owner of the herein described property. I have auth --� h �Cw�-A �(-Ll� <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 />S <br />, d <br />Tam rtauestWLT this variance for property located at <br />Site Plan Minor Development Site Plan <br />Maj or 1) evelo p men t Site Flan GeneralPlan <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 />r--- --- <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 />Meetirg Date: <br />Notice to surrounding property owners- Date: <br />licant's Signature <br />Board's Decision: Approved () Denied () <br />Notice of Boards Decision mailed to Applicant/Owncr- - <br />