SBA 1994-25478-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
0 CASE NO:
CITY OF LA QUINTA FEE: $100.0
PLANNING & DEVELOPMENT DEPARTMENT �—
APPLICATION FOR SETBACK ADJUSTMENT
91
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.
PLEASE PRINT
OR TYPE
APPLICANT/CONTRACTOR:
CONTACT PERSON ( I F DIFFERENT)
MAILING ADDRESS: V -CiD Alkudk4o'
/' Q?dye4—
(Address) (City)
OWNER'S NAME:
MAILING ADDRESS: .%A - d X,6144W
!-�
DATE `- y� s5 I
PHONE 3 0 - l U
(State) (Zip
PHONE f11Y '�537
ess) (City) (State) (Zip
STREET ADDRESS OF PROPERTY:
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
RECEIPT City .a Quinta, 78-495.C1alnle Tampico, P. O. YC1.5504, La Quinta CA 92253
DATE 19 1 NO. 6.
RECEIVED FROM
ADDRESS
DOLLARS $
FO
_O ACCOUNT HOW PAID
AlsCOU CASH
"`ACCOUNT
AMT. PAID CHECK
ALANC BY
DUE ORDER
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APP ED B P ANN, mviivo8 DEVELOPMENT D.EPART.fyEpj-r
8 DATE* 4La2Z
EXHIBIT
CAUSE I'Va.