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<br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />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 /> <br /> <br /> <br />Applicant: <br /> <br />--~{\(L ~ ~ ~~ <br />Name <br /> <br />\D'6~q Z. L\{,~ De.. <br />Address <br /> <br />PH: 2~\ .'EL\2-qol~ <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"': ~.~ ~ ~'h", ~ <br />Name <br /> <br />\OD,\q 2:. L\VlLO~ Ue PH: 2~ \-8-\2-QOI3 <br />Address <br /> <br />I am requesting a Special Exception to Sect. <br />of the Code of Ordinance. <br />I am requesting this Special Exception for property located at <br /> <br />of the City Zoning regulations Chapter 106 <br /> <br />,O~~ f. Gn~ ~ <br />Street Address <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 ofreliefl 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 Authori tio!! to a~ the Ower's behalf. <br /> <br />I ~~, <br /> <br />Applicant's Signa r <br /> <br /> <br />Office Use Only <br /> <br /> <br />Site Plan and Authorization (if applicable) attached? Yes 0 No 0 <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 />