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City of South Bend 227REGlEMED0nOET581a20211oos <br /> BOARD OF ZONING APPEALS South Bend, IN af��o1 <br /> Petition for Variance - Special Exception <br /> Property Information DAWN M.JO iEs12) /I, <br /> Q CITY CLERK,SOUTH 6 Llt__ <br /> Tax Key Number: o(� <br /> Addre i--i--7 <br /> Owner: )161)a <br /> Zoning: Choose the current district u 3 <br /> Project Summary: <br /> WOrYYLA <br /> Ne <br /> (3L-- 411 d-D 9413)4 <br /> L <br /> Requested Action <br /> Special Exception/ Use Variance— complete and attach Criteria for Decision Making <br /> Use requested: CIro4I.QSi AC,Q. <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 Information) <br /> ❑ Site Plan drawn to scale <br /> ❑ Filing Fee <br />