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.CITY OF LA PORTE0 <br />ZO IG BOARD OF ADNSTME <br />VARIANCE REQUEST <br />Application No.: oil - caq <br />OFFICE USE ONLY: Fee: $150.00 Date Received: <br />Receipt No.: d D F, 8' <br />Note: This Fee is Non -Refundable Regardless of the Board's Decision <br />Applicant: le hA e 1 I'(7ai1C151 <br />Name - <br />� 5 . Ce3cre-et <br />Address Phone <br />I am the owner of the herein described property. 1 have authorized \I <br />to act on my behalf in this matter. 4 I _14 tlq ,., <br />Owner*: 1gnj) lr ?Ye { <br />Name <br />1501 CeoLcr <br />Address Phone <br />I am requesting a variance to Sect. IV •-Iq 7— of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. <br />I am requesting this variance for property located at ,! rrnp t" ri NA Ietzit <br />Street -Address <br />ord Strut <br />Legal Description <br />0 Site Plan Minor Development Site Plan <br />(k) Major Development Site Plan 0 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 />n _ <br />ate Applicant's Signature <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 Boards Decision mailed .to Applicant/Owner: <br />