1. Appeal Number: __________

2. Filed: __________

3. Notice Received: __________

4. Twenty-First Day: __________

5. Forty-Second Day: __________

6. Staff Assigned: __________

1. Name(s), address(es), and telephone number(s) of appellant(s):

2. Name(s), address(es), and telephone number of appellants' representative, if any:

3. The local governmental action was taken by ____________________. The action was taken on ____________________ and is or is not final (circle one). If the action is not final, an appeal may be taken to ____________________ within ___ days of ___. The knowledgable local official is ____________________ who may be contacted at ____________________

8. Attach a complete, but brief, statement of facts explaining and substantiating why the proposed development does not conform with the certified Suisun Marsh Local Protection Program or Program Component. The statement should refer to all applicable policies, ordinances, and regulations by name and page number. The appellant must demonstrate to the Commission that the appeal raises a substantial issue. The Commission shall hear an appeal unless it determines that the appeal raises no substantial issue as to conformity of the proposed development with the provisions of the certified Suisun Marsh Local Protection Program. *

* The Suisun Marsh Preservation Act provides that the Commission must hear an appeal if a substantial issue of compliance exists with either the Marsh Act, the Marsh Plan, or the certified Local Protection Program. However, the Act also provides that the Commission must issue a marsh development permit on appeal unless a substantial issue of compliance exists with the certified Local Protection Program. Therefore, this appeal form strongly encourages an appellant to limit his or her discussion and analysis to issues of compliance with the certified Local Protection program.

CERTIFICATION:

I declare that the foregoing is true and correct to the best of my knowledge and I understand that any misstatement or omission of the information requested may be grounds for rejection of this appeal.