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APPEAL FORM <br /> URBAN DESIGN COMMITTEE <br /> Have you received an Official <br /> ADDRESS OF PROPERTY Notice concerning this matter? <br /> NAME OF APPELLANT / / YES �, . NO <br /> ADDRESS OF APPELLANT Have you been refused a <br /> permit application? <br /> CASE NUMBER <br /> DATE FILED / / YES / / NO <br /> DATE OF HEARING SCHEDULED <br /> In order for you to appeal a decision of the Building Inspection Superintendent, your <br /> appeal must fall within one or more of the following categories: <br /> 1. Do you believe a rule has been incorrectly interpreted? Explain. <br /> 2. Do you believe you would suffer a manifest injustice? Explain. <br /> 3. Do you believe the code does not apply? Explain. <br /> 4. Request to determine the suitability of alternate plantings. Explain. <br /> RETURN TO: Madison Building Inspection Department <br /> Attn: Linda Dittherner <br /> 210 Monona Avenue APPROVED <br /> Room 109, City-County Building <br /> Madison, WI 53709 <br /> DISAPPROVED <br /> Date <br />