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ZOACITY OF LA PORTE <br />G BOARD OF ADJUSTME4 <br />VARIANCE REQUEST <br />APplicatiori No.: - <br />OFFICE USE ONLY: Fee: $150.00 Date Received: — `b =0.3 <br />Receipt No.: _ <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />Applicant: <br />ri` ve Z <br />Na W <br />7 A. <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 />Name <br />Address Phone <br />I am requesting a variance to Sect. !191 (�Z) of the*City Zoning regulations Chapter 106 of the <br />Code of Ordinance. ,.,{ <br />I am requesting this variance for property located at IU Poo <br />T� /� �f /� / Street Addr�ee _ <br />, �V '�'�1 Omf. o r �/t/, f' Arr.! /�hl f/•tc f /vd, �O ��i�J, L.rn+fy, 7X <br />Legal Description <br />(Jj 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 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 />Date Applicant's Signature <br />Office.Use Only <br />Site Plain. and Authorization (if applicable) attached?. Yes () No ( ) <br />Date transmitted to the Board of Adjustments:. <br />Meeting Date: I a �7 10,3 Applicant Notified of Date: % / l e.A 3 <br />Notice to surrounding property owners -Date: <br />Board's Decision: Approved () Denied () <br />Notice of Boards Decision mailed to Applicant/Owner: <br />