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<br />CITY OF LA PORTE <br />ZONING BOARD OF ADJUSTMENT <br />V ARlANCE REQUEST <br /> <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 />VO~"oOS <br />I,,;)..q-og <br />1;2.3~(ote <br /> <br />Applicant: <br /> <br />~LtI-t(lO (-)Qrl~Ov <br /> <br />. Name <br /> <br />CJ1D4 k"j Lu:tkOf'\ 'bfr ln~ Tt7f;J1 <br /> <br />ddress <br /> <br />X3d __ 5i'I-dTlf-~ <br />Pboneg3~-Gfl3..JSc::> D <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 <br /> <br />Phone <br /> <br />I am requesting a variance to Sect. oUhe City Zoning regulations Chapter 106 of the <br /> <br />Code of Ordinance. A 'd h LJ h ~ <br />I am n'q uesting this variance for property located at~.;I1 . I ~{' -e Or- -+e ,~l15 <br />S eet Address <br /> <br />Legal Description <br /> <br />() Site Plan <br />() Major Devdopment 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 al,plieant is NOT th e owner, he must provide AuthO~_ act on the Owner's behalf_ <br /> <br />1-JQ-Or;? ~~ <br />Date Applicant's Signature <br />Office Use Only <br />Site Phn 2nd Authorh.ation (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 />Notice to surrounding property owners- Date: <br /> <br />Board's Decision: <br /> <br />Approved ( ) <br /> <br />Denied ( ) <br /> <br />Notice of Hoards Decision mailed to Applicant/Owner: <br />