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A��. . Appeal Form <br /> appeal the decision made by the <br /> (Your Name) regarding <br /> Planning Commission on <br /> (Date of Action) <br /> Z7 y <br /> (File Number and Name of Item) <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 /> ,� <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 belie_`. <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 /> 'A_ C / Ue.) <br /> © I attended the public hearing on _ S <br /> ❑ I was prevented from participating by circumstances beyond my <br /> control attach explanation) . <br /> Signed <br /> t� 0 <br /> �.., l-'i°��,r-,. Date ! – / /-7 <br /> �-✓ �-� <br /> Name �� r �� t — (7 Vii✓ 7/-�4 <br /> Address <br /> City/Zip Code q ,sy <br /> T Telephone <br /> i'i /✓'i�i � <br /> FOR OFFICE USE ONLY <br /> Appeal Fee <br /> ZSOQ` Receipt Number /sI DOS <br /> Approximately how much time to allow for the appeal <br /> Date <br /> Appeal accepted by (7/84) <br /> —1— <br />