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I 102 <br /> appeal the decision made by the <br /> g (Your Name <br /> Plannin Division on regarding <br /> ( Date of Action ) <br /> (File Number and Name of Item) <br /> BASIS OAPPEAL <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 /> 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 ch n d or removed: S C <br /> v Gf/Z <br /> State facts c9ptrary to the decision ( list any facts that support your <br /> ap <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 <br /> 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 /> Signed / ��y' D a t e _ <br /> ,� � ' <br /> Name ' rLF G P PS l i.1/i ry �Jr ynC. <br /> Address P. (9, 3 <br /> City/Zip Code �,y, ;„�e_ CA- -7'c5 9 Telephone�2��`�� C,� - 7� �_� <br />