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CITY OF LA PORTE <br />ZONING HOARD OF ADJUSTST <br />SPECIAL EXCEPTION REQUEST- <br />---------------------------------------=--------------------- <br />-----7� - <br />Application No.: L�__- U <br />OFFICE_ USE_ ONLY: - Fee: __ ;$50.00 Date Received: <br />Receipt No.: <br />NOTE: This Fee is Noh-Refundable-Regardless of'the Board's Decision. <br />Applicant. --'"-----___-•----__._......----- <br />-r_c_ f_� <br />' _- - ---- - - - -- -_ <br />Name 44 <br />,_.,�7 / / <br />77 PH : �749J <br />Address. .6 D5- <br />�. <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 />P H : Co7�1�,=ZOD.3 <br />Address f <br />779 l <br />I am requesting a. Special Exception -to Sect. of the City <br />Zoning Ordinance No. 1501. I am requelstin this Special Exception for <br />property located at _� ��� � _l.. �.�r!' �. (.3._9_l-f EnaG�, <br />Address T Legal 1Tescri ti.on <br />g P <br />(VY"'Site Plan ( ) Minor Development Site Plan. ` <br />( ) Major Development Site Plane ( ) 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 ha's 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 <br />on the Own is behalf. <br />� /03 A , - <br />Date Applicant's Signatur <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: _ Applicant Notified of Date: <br />Board's Decision: Approved (- ) <br />Denied ( ') <br />Notice of Board Decision mailed to Applicant/Owner: <br />