SBA 1992-101a
78-105 CALLE ESTADO — LA GUINTA, CALIFORNIA 92253 - (619) 564-2246
16 `LASE NO: ID - 10 1
CITY OF LA QUINTA EE: $100.00
PLANNING & DEVELOPMENT DEPARTMENT
APPLICATION FOR SETBACK ADJUSTMENT
APPLICANT: Submit this form with two copies of a scaled site plan,
drawn to adequately depict the nature of the request. A nonrefundable
fee of $100 is required when the Application is submitted. Check must be
make payable to the "City of La Quinta".
If the Applicant is not the owner of the property, a letter must be
submitted by the owner authorizing the Applicant to execute this document
in his behalf.
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PLEASE PRINT OR TYPE
APPLICANT/CONTRACTOR: 1,06 dWfbff% MM&0,,) DATE��„ G� �I 14M*1
CONTACT PERSON ( I F DIFFERENT) 190 PHONE 1'4• & G(w'SC*6
MAILING ADDRESS:
ss) OWN J
OWNER'S NAME:
MAILING ADDRESS: S 15aS arVerli(om 1-1
Address
STREET ADDRESS OF PROPERTY:( C-0(Z-
LEGAL DESCRIPTION OF PROPERTY: LOT #
Afol
PHONE
City) (State) (Z
P TRACTS , �A1
ASSESSOR'S PARCEL NUMBER: 7 0 861l 03-25-92 i0
ASH i TOTAL i i00.00
ADJUSTMENT REQUESTED: 9, O 7O
INT1W!i�1M
REASON FOR REQUEST : TQ C"A4"!1C Man Imersomwam ' m
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JUSTIFICATION: No request for a Setback Adjustment shall be granted
unless it is determined that it is consistent with the intend and purpose
of this Ordinance; that there are special circumstances applicable to the
property, including such factors as size, shape, topography, location or
surroundings that justify the approval of the adjustment of the setback
requirement, and that the adjustment will not be detrimental to the
health, safety, and general welfare of the community or be detrimental to
property in the area of the parcel for which the adjustment is requested.
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FORM.013/CS
t
1 .
{ CITY OF LA OUINTA
j 005182.10 8611 03-25-92
. SO f
MISC. 1 100.00
0013400034010
'
10
CASH 1 TOTAL i 100.00
i AMOUNT TENDERED I00.00
CHANGE .00