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SBA 1992-12978-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - (619) 564-2246 W CASE NO: CITY OF LA QUINTA FEE: $100.00 PLANNING & DEVELOPMENT DEPARTMENT APPLICATION FOR SETBACK ADJUSTMENT APPLICANT: Submit this form with two copies of a005182 39calr'dR 1ti EMn,i00.00.i4 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. PLEASE PRINT OR TYPE APPLICANT/CONTRACTOR: VQ .e 1�0, f,-i-/cy\_ j& DATE CONTACT PERSON (IF DIFFERENT) PHONE MAILING ADDRESS: (Address) - (City) r �- (Statef- Z OWNER'S NAME: PHONE -3 Ji4J MAILING ADDRESS: _1 ��� (Address)(City) (State) (zip) STREET ADDRESS OF PROPERTY: IBC G� LEGAL DESCRIPTION OF PROPERTY: LOT # TRACT ASSESSOR'S PARCEL NUMBER: ADJUSTMENT REQUESTED: -3' REASON FOR REQUEST: ************************************************************************** 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. ************************************************************************** FORM.013/CS LoT 4� DOITINA GEORGE GOLDMAN 44 - 61-5 SAFFRO`i ' CT. LA OUIITA,CA. 345-6571 PLOT PLAN FOR SWI2l`ING POOL 7/25/92 APPR ED, PLANNING DIVISION �y