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t , <br /> W" Appeal Form <br /> Cf�C�FOR��r <br /> I QOL eci appeal the decision made by the <br /> (Your Name ) <br /> Planning Division on T"�� ( �{- j �(Cjo regarding <br /> (Date of Action ) <br /> 1'Yl S . - Q�� - I ( CC <br /> (File Number and Name of Item) <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 /> 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 /> +-(,c r•�r_r( r ( f -}{.�i. Vru,.-` —r� HCl,,.. ( :2 i c- <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 /> 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 /> Q I am directly and adversely affected by this decision. <br /> Signed _.� Date <br /> Name <br /> Address <br /> City/Zip Code _Telephone 53/-2zr�z <br /> ti <br /> FOR OFFICE USE ONLY <br /> Appeal Fee 2 4 Receipt Number <br /> Approximately how much time to allow for the appeal ,•� , ,;i __ <br /> Appeal accepted by :moi Date <br /> ( 7/84 ) <br />