Glenaire E 4415 Larry Davidson Decision Appeal
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OCT Z 8~~ TO THE 80ARD OF COUNTY CON~1I'SSIONERS
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N" COMMISSIONERS Appea 1 Fee- $100 0 1
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Name : A4-41 oGi (Yt trt'~ Today' s Da te d ~ i
address : ~ '51~~~ ~ Zi p Code: ' 2 20 v `
Home Phone: Business Phone: W3_ 6>&
Hearing Examiner Committee Action 6eing Appealed
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Pretimi nary Subdivision Number: S" .
Zone Reclassification Number:_2&.,37 -,G A0.1 -69dz
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~ Date ea iExa iner Committee Action:
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~ Signatur . - - - ' , ' ,
Signature of Authorized Representative: ,
Address : • YOUR REASONS FOR APPEAL
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OFFICE USE ONLY
Copi es to : P1 anni ng. /(4/d Engi neers A4"4,) Env i ronmental Heal t _
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Fee Received: ChecCash Receipt Number
Hearing Date: