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�eadli n� ��i 5, -��-a- -�' 0 5 2-022 <br /> /N M.JONES <br /> Cityof South Bend �- 30tJTHBEf �,�{ Jefferson - Suite 14005 <br /> . _ ._ Bend. I N 46601 <br /> BOARD OF ZONING APPEALS zoning@southbendin.gov <br /> Petition <br /> Property Information <br /> Tax Key Number: OAS —SC)a-E — 07 0 <br /> Address: 4) / 0 4. . I <br /> Owner: i 1 r rT le-2— <br /> Zoning: Choose the current district r <br /> Project Summary: W cx�� �a C 1 �&r �v) 0"U�0 j <br /> J.. J-1 <br /> Requested Action <br /> 1K Special 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: <br /> Required Documents <br /> ❑ Completed Application (including Criteria for Decision Making and Contact Inform_ ation) <br /> ❑ Site Plan drawn to scale <br /> ❑ Filing Fee Clerk's Office <br /> f Y' U 5 ?022 <br /> iil-JONES <br /> C:11'0LERK, SOUTH BEND, IN <br />