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Appeal Form <br /> .fi <br /> r <br /> appeal the decision made by the <br /> (Your Name) <br /> Planning Commission on �- 2 — 9� regarding <br /> 9 9 <br /> 7, (Date of Action) <br /> (File Number and Name of Item) <br /> BASIS FOR <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 chang d r removed: <br /> /o i v e <br /> c <br /> g4 44Z,-7S <br /> s h e <br /> State facts contrary to the decision (list ny facts that support your <br /> appeal) :J s0,0 al__11 X0 4he <br /> �.A�J`riISS/o41 ih �r Pr �r�o cil�O��/ o ZlP o r � <br /> 5 6 o s U i or <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 /> F� consent to the appeal) <br /> ❑ I submitted oral or written testimony on the application. <br /> I attended the public hearing on to - 20— 9 <br /> ❑ I was prevented from participating by circumstances beyond my <br /> control (attach llexplanation). Q c� <br /> signed X' Date <br /> Name O e Se, h e_ / <br /> Address 2pVe <br /> City/Zip Code C Telephone 33- <br /> FOR <br /> FOR OFFICE USE ONLY <br /> Appeal Fee OOH Receipt Number 263943 <br /> Approximately how much time to allow for the appeal <br /> Appeal accepted by Date <br /> (7/84) <br /> -1- <br />