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<br />~ITY OF LA PORTE <br />ZONI~\.Y BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST {:'(..,. <br />Application No.: Db - DD _ <br />OFFICE USE ONLY: Fee: $150.00 Date Received: 10 -;"2.,- 2CO'S <br />Receipt No.: L/-f70 <br />Note: This Fee is Non-Refundable Regardless of the Board's Decision <br /> <br />Applicant: <br /> <br />!(;dkr ~ 1A~ l(l/v <br />/ Name <br /> <br />311 C) PllYll'~ <br />Address <br /> <br />PH: a/ll - Lf 11- 7 f ;)-!{ <br /> <br />I am the owner of the herein described property. I have authorized <br />to act on my behalf in this matter. <br /> <br />Owner* : <br /> <br />j/1Rty N~AA/ <br /><.3 I / <j Ptn1~ vr-J <br />Address <br /> <br />PH: J;>>(I-'-f7/-7~ 25t <br /> <br />I am requesting a Special Exception to Sect. / d ~ /9 / of the City Zoning regulations Chapter 106 <br />of the Code of Ordinance. <br />I am requesting this Special Exception for property located at 'I tf.s- ~ ~ fJ IJ /t..t--- <br />Street Add ess <br /> <br />Legal Description <br /> <br />( ) Site Plan <br />() Major Development Site Plan <br /> <br />( ) Minor Development Site Plan <br />( ) General Plan <br /> <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! 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 /> <br />~~~ <br />,/ pplicant' Ignature <br />Office Use Only <br /> <br />/ () -; 2--- tf. S- <br />. <br />Date <br /> <br />Site Plan and Authorization (if applicable) attached? Yes () No () <br /> <br />Date transmitted to the Board of Adjustments: <br /> <br />Meeting Date: <br /> <br />Applicant Notified of Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Boards Decision mailed to Applicant/Owner: <br />