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City of South Bend <br />BOARD OF ZONING APPEALS <br />Property Information <br />Tax Key Number: <br />Address: —JY-1 <br />Owner: <br />Zoning: Choose the current district <br />Project Summary: <br />Requested Action <br />especial Exception – complete and attach Criteria for Decision Making <br />Use requested: <br />❑ Variance(s) - List variances below, complete and attach Criteria for Decision Making <br />Variance(s) requested: I <br />p/1v�L%f\I it) �Sfir�bliSl��i <br />1� 1 <br />2 <br />51 f ��yry aY(U 5LYe2hl�� <br />3° <br />Required Documents <br />❑ Completed Application (including Criteria for Decision Making and Contact Information) <br />❑ Site Plan drawn to scale <br />❑ Filing Fee <br />