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I LAPeY appeal the decision made by the <br /> (Your Name ) <br /> Planning Division on Jl+UU42V 17 199p regarding <br /> ( Date of Action ) <br /> Co0�1TOtilS OF App,QD,JAL SA (q - 4- <br /> (File Number and Name of Item) <br /> BASIS FOR APPEAL q <br /> Be thorough--only the findings and facts you <br /> include in your appeal will be considered at <br /> the appeal hearing . Attach additional sheets <br /> if necessary. <br /> State the basis of the appeal (list any findings of fact made by the <br /> review authority which were wrong and the reasons why they are wrong ) . <br /> If you wish to appeal a specific condition list it and the reasons <br /> the condition should be changed or removed: <br /> EE-A77-4, - <br /> TT-Ktir +�.� T-F-2 <br /> State facts contrary to the decision ( list any facts that support your <br /> appeal ) : <br /> I realize that this appeal will prevent action on this item from <br /> becoming effective and that no permits will be issued until final <br /> action on the appeal is taken. The above is true to my own knowledge, <br /> information or belief . <br /> DO NOT SIGN UNTIL YOU HAVE READ THIS FORM. <br /> I certify under penalty of perjury that the foregoing is true and <br /> correct and that I am (check one ) : <br /> Q Applicant <br /> M�Agent (If an agent, attach proof of the applicant ' s consent <br /> to the appeal . ) <br /> I am directly and adversely affected by this decision. <br /> SignedDate �1z�j /�t`jp <br /> Name i> o o ��so✓ - Huscll E u uric <br /> Address 01 ro - Z c + <br /> City/Zip Code Telephone Zo5- 57-i- ggg(, <br />