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CITY- OF LA FORTE <br />7fk1ING BOARD OF ADNSTJ&NT <br />VARIANCE REQUEST <br />Application No.: 03 -- 00..3 <br />OFFICE USE ONLY: Fee: $100.00 Date Received: Q fr^ D <br />Receipt No-" <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision. <br />Applicant: <br />Name / <br />�ayee4Ar� <br />Address Phone <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 />N e <br />ny4 , / di ��. 003- <br />Address Phone <br />I am requesting a variance to Sect. % D 02 of the City Zoning Ordinance No 1501. <br />I am requesting this variance for property located at <br />3 / ,r 3 3 cZ Sty Address ,. <br />Legal Description <br />--k-)` 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 information requested below <br />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 act <br />behalf. <br />_._......_......Date........... . _._w_._._ ......_ ....._...._..�. <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 />Notice to surrounding property owners - Date: <br />Board's Decision: Approved () Denied ( ) <br />Notice of Board Decision mailed to Applicant/Owner: <br />on the Owner's <br />