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Appeal Form <br /> e, `� <br /> �� <br /> I j w Q J ppeal the decision made by the <br /> (Your 'N4me ) ' <br /> Planning Division- on o3- 9— $ regarding <br /> Date of Action ) <br /> (File Number #'nd Nate of Item) <br /> BASIS FAPPEAL <br /> OR <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 /> 1 <br /> State facts contrary to the decision (list any facts that support your . <br /> appeal ) : <br /> n <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 /> am directly and adversely� affected by this decision. <br /> Signed Date `7 <br />