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ZOACITY OF LA PORTS <br />G BOARD OF ADNSTMENO <br />VARIANCE REQUEST <br />Application No.: - <br />OFFICE USE ONLY:" Fee: $150.00 Date Received: ! • 2 - c� �l <br />Receipt No.: <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />Applicant: aAme ✓1 x%S -0-5 <br />Name <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. <br />Phone <br />I am requesting a variance to Sect. VJ -/ 2- of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at �i� oS' e 4-• <br />Street Address <br />%z. o i as✓e �c5 SJY:: r fir k- <br />Legal 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 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 />bate Applicant's Signature <br />Office Use OVNo <br />Site Plan and Authorization (if applicable) attached? Yes (' <br />Date transmitted to the Board of Adjustments: — , ' 0 `7' <br />Meeting Date: ()I-' a a - a Al Applicant Notified of Date: y <br />Notice to surrounding property owners- Date: <br />Board's Decision: Approved () Denied () <br />Notice of Boards. Decision mailed.to Applicant/Owner: <br />