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<br />Applicant: <br /> <br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />SPECIAL EXCEPTION REQUEST <br />Application No.: 'j 8' Ota .. (C)()[ <br />Date Received: ) 21 I ~~ og <br />Receipt No.: g C1Q:2 . <br />This Fee is Non-Refundable Regardless of the Board's Decision <br />I / <br /> <br />VttlCENT (t:Lt1S <br />N e <br /> <br />/t;J./4 51 S(JflA~7JR. ?stflAdIJ al <br />Address '115~ 1- <br /> <br />Fee: $150.00 <br /> <br />OFFICE USE ONLY: <br /> <br />Note: <br /> <br />P~~ :1!1-g/3-~:Z <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 /> <br />PH: <br /> <br />Address <br /> <br />I am requesting a Special Exception to Sect. of the City Zoning regulations Chapter 106 <br />ofthe Code of Ordinance. IA Ih G. <br />I am requesting this Special Exception for property located at CJ"j-.I JAK lk!O Y.t:. <br /> <br />1. ' E tJ if II ~ 7 4 Street Address ~. () <br />, ~7/~ ~;,4(Jr II ~~on' JJ;rfllt'f.~ JoJlllSJN - fJITfR ul!fflJ <br /> <br />Site Plan <br />( ) Major Development Site Plan <br /> <br />( ) Minor Development Site Plan <br />( ) General Plan <br /> <br />A Site Plan ofthe 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 ofreliefI 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 Authoriza io <br /> <br />j)Ff.'t=I1BEJ< 1~2tO? <br />Date <br /> <br /> <br />Office Use Only <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 />