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<br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />V ARlANCE REQUEST <br />Application No.: ---1/'rJ 7 - 0 {} LJ <br />-.OFFICE USE ONLY: Fee: $150.00 Date Received: f, ~R-07 <br />Receipt No.: I 0 4.t1 n <br />Note: This Fee is Non-Refundable Regardless of the Board's Decision · , <br /> <br />Applicant: <br /> <br />\Z;r-p JttI rt I H:; <br /> <br />Na e <br />, ~ <br />(/)/4-S. ,<:;IJI1At2,j)R~ fJA&!AN'lJ)tX/7504 <br />Address <br /> <br />2g/"513-rJJ~ <br /> <br />Phone <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 />Name <br /> <br />Address Phone <br /> <br />I am requesting a variance to Sect. lOt:, 74/ of the City Zoning regulations Chapter 106 of the <br />Code of Ordinance. ~ a ~ <br />I am requesting this variance for property located at t.f: ~ ~.f: <br /> <br />in .E j ~ Street Ad4Jess 1i.i 7 <br />r /CI/ f;z OF/.. Or 11, &. (OJj;z;rj 5Ifr:fF:- 1Ji~ K ~N/) C1' <br />Lega 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 I am seeking (setbacks, lot coverage, etc.). <br />c) The grounds upon which I am making this request. <br />* If al:plkant is NOT the owner, he must provide Authorization to act on the Owner's behalf. <br /> <br />il r/ 07 <br /> <br />{ Date Applicant's Signature <br />Office Use Only <br />Site Pl:1D ~nd Authorization (if applicable) attached? Yes () No () <br /> <br />Date transmitted to the Board of Adjustments: <br /> <br />Meetir,g Date: <br /> <br />Applicant Notified of Date: <br /> <br />Notice to surrounding property owners- Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Boards Decision mailed to Applicant/Owner: <br />