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<br />CITY OF LA PORTE <br /> <br />ZONING BOARD OF ADJUSTMENT <br />VARIANCE REQUEST <br /> <br />--------------------------------------------A~~l~~~~~~~-~~~~-9~=-~D3-~ <br /> <br />OFFICE USE ONLY: Fee: $100.00 D~te Received: ...3~;l.~-W <br />Receipt No.: 1s/d_ <br />NOTE: This Fee is Non-Refundable Regardless of the Board's Decision. <br /> <br />Applicant: <br /> <br />LA f61l -ref" J-"JE1...e'1 ; ~AN <br />. Name <br />I-/r G 1-11"01,4'1 /4' S. <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 /> <br />')-0 I <br /> <br />PH: <br /> <br />41 0 ~ 1.-)... q '8 <br /> <br />Owner*: <br /> <br />C, L, (;T-e-12- --r <br />Name t4 <br />~ 0 I /-j 'AY)' lye > ~ l{ <br />Address <br /> <br />PH: 4JO;,L7~ <br /> <br />I am requesting a variance to Sect. of the City Zoning <br />Ordinance No.1 01. I am requesting this variance for property located <br />at ;:l.. b '<; H-lJJ I ~b S. <br />Street Address Legal Description <br /> <br />( ) Site Plan ~ Minor Development Site Plan <br />(tr? Major Development Site Plan ( ) General Plan <br /> <br />A Site Plan of the property is attached. Also, I have listed the <br />information requested below on the follo\~ing pages of this form. <br />a) All facts concerning the matter that has led upto 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 /> <br />* If applicant is NOT the owner, he must provide Authorization to act <br />on the Owner's behalf. <br /> <br />Date <br /> <br />Applicant's Signature <br /> <br />----------------------------------------------------------------------- <br /> <br />OFFICE USE ONLY <br /> <br />Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) <br /> <br />Date transmitted to the Board of Adjustments: <br /> <br />Meeting Date: <br /> <br />Applicant Notified of Date: <br /> <br />Notice to surrounding property owners - Date: <br /> <br />Board's Decision: <br /> <br />Approved <br /> <br />Denied ( <br /> <br />Notice of Board Decision mailed to Applicant/Owner: <br />