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o Appeal Form <br /> I liN/9{'ISE S //v �iC C' appeal the decision made by the <br /> (Your Name) <br /> Planning Commission on _—_.27 FZ _ regarding <br /> Z—,2 C9 (Date of Actin) <br /> (File- Number and Name of Item) <br /> BASIS FOR APPEAL <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 /> Planning Commission which were wrong and the reasons why they are <br /> wrong). If you wish to appeal a specific condition list it and th <br /> reasons the condi t'on hould a changed or rem ved: <br /> '27 4Z,6;F42 <br /> State facts contrary to he de ion list arry facts t at sdpport�your <br /> appeal <br /> L2 O <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 /> SIGNATURES <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 /> Applicant ❑ Agent (attach proof of the applicant's <br /> consent to the appeal) <br /> F-11 submitted oral or written testimony JJon the application. / <br /> ❑ I attended the public hearing on <br /> �] I was prevented from participating by circumstances beyond my <br /> control (attach expI tion) . J <br /> Signed(- D� /'a}t'e / I <br /> Name / s //v <br /> Address <br /> City/Zip Code ephone <br /> FOR OFFICE USE ONLY <br /> Appeal Fee $ o0 Receipt Number <br /> Approximately how much time to allow for the appeal 2 Y-011 <br /> Appeal accepted byDate <br /> (7/84) <br /> —1— <br />