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CITY OF LA PORTE RiE-CE IV E D <br />ZO G BOARD OF ADJUSTMEN -- s 4 <br />APR 200 <br />VARIANCE REQUEST <br />Application No.: <br />OFFICE USE ONLY: Fee: $150.00 Date Received: <br />Receipt No.: <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />name <br />/49/2 �i�+Joac� <br />Address <br />7/3-5 1? <br />z_ 8/- 9 71- 7/'2 <br />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*: worx-,L, <br />Name 8 �9 -,f'a / p t•' <br />/09iz `fti, oope/ 28/ -YZ/ - 7fJ-a--��--- <br />Address Phone <br />I am requesting a variance to Sect. of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at _/4 1T/Z <br />Legal Description <br />(a'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 AuthorizatigWto act on the Owner's behalf. <br />y-e Z - oV <br />Date <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: <br />Applicant Notified of Date: <br />Notice to surrounding property owners- Date: <br />Board's Decision: Approved () Denied () <br />Notice of Boards Decision mailed to Applicant/Owner: _ <br />nt's <br />ature <br />