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CITY OF LA PORTE <br />• ZONING AOARD OF ADJUSTI~TENT <br />SPECIAL EXCEPTION REQUEST SF <br />--------------------------------------------Application tvo. ~- D <br />OFFICE. USE_.ONLY: Fee;___ $5_0_.00 Date Received: ~_O~~a-l'~-[~_ <br />Receipt No.. _ ~!/_fA <br />. NOTE: This Fee is Non-Refundable Regardless of the Board's Decision. <br />Applicant. t~-~ ~_~11:~.~5__~.bs~'~-•--•---.~!Z.l.~,~__.21'~oS~_. . <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 />....._-----•-.._.___.--_.__ ~_ ____.__.--------~-•--•---------•-~ PH. -~_._._._ <br />Address <br />I am requesting a Special Exception to Sect. IOG~-19~J-~2~ of the City <br />Zoning Ordinance No.~1501. I am requesting this Special Exception for <br />property located at ___~yl_ ~.K_~LnJ~__._._._ ____ .__~ <br />~~ Address ~ Lega~ Description <br />( )Site Plan ( ) Minor Development Site Plan <br />( ) Major Development Site Plan ( ) General Plan <br />A-Site Plan of the property is attached: Also, I have listed the <br />information requested below on•the 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 ac.t <br />on the Owner's behalf. <br />Date ~ Applicant's Signature <br />OFFICE USE ONLY <br />Site Plan and Authorization (if applicable) attached? Yes ( ) No ( ) <br />Date transmitted to the Board of Adjustments: __i __. <br />Meeting Date: __._._.____.___. Applicant Notified of Date: ___.._.__.....__.._ <br />Board's Decision: Approved ( ) Denied ( ) <br />Notice of Board Decision mailed to Applicant/Owner: __~.......___.__.___._ -- <br />