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Appeal Form <br /> r. <br /> (��,aQpeal the decision made by the <br /> (Your N e) <br /> Planning Commission onZ�•;. /�?�"'� �L/��// regarding <br /> C Mate of Acton) <br /> llor .S,-,,C,C)i L'/S/ C_ cik-- <br /> (File Number and Name of Item) --Tv <br /> BASIS FOR APPEAL <br /> B <br /> - <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 the <br /> reasons the condition should be changed or removed: <br /> !fit <br /> mat- Zgl- -�- - -Yt - <br /> Sta a facts contrarly to the decision (listany acf is that support your <br /> appeal) : �� <br /> � ' f <br /> ry— <br /> �.. <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 /> Applicant Agent (attach proof of the applicant's <br /> consent to the appeal) <br /> ® I submitted oral or written testimony on the application. <br /> f attended the public hearing on ` -/g <br /> ri-- <br /> F-J t was prevented from participating by circumstances beyond my <br /> control (attach explanation) . <br /> p / <br /> Signed / �rr� Pry/tom Date <br /> Name Y <br /> Address O -T- <br /> City/Zip Code C 52 (o Telephone 53/_._466 <br /> FOR OFFICE USE ONLY <br /> Appeal Fee �W'OG Receipt Number Zcoq (0 <br /> Approximately how much time to allow for the appeal VZ Noun <br /> Appeal accepted by 1n-,//.< Date <br /> Vft- (7/84) <br /> -1- <br />