An appeal is hereby made to Your Honorable Body from the decision of the
Site Plan Review Committee
Zoning Administrator
Planning Commission
Cultural Heritage Commission
Which was taken on the _______ day of ________________, 20 ____.
Project Address: ____________________________________________________________
I/We, your appellant(s), hereby respectfully request that Your Honorable Body reject the decision
and Approve / Deny the application or permit in question.
ALL INFORMATION BELOW IS REQUIRED
Reasons for Appeal: ________________________________________________________
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__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
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Appellant Name(s): ___________________________________________________________
Organization (if representing) ___________________________________________________
Address: ___________________________________________________________________
City ________________________ State _______ ZIP _______ Phone __________________
Signature(s) _______________________________________________ Date ____________
• A separate appeal form is required for each appellant party, except for appellants from the
same address, or an appellant representing an organization.
• Appeals must be filed within 10 days after the decision is made (LBMC 21.21.502).
• You must have established aggrieved status by presenting oral or written testimony at the
hearing where the decision was rendered; otherwise, you may not appeal the decision.
• See reverse of this form for the statutory provisions on the appeal process.
BELOW THIS LINE FOR STAFF USE ONLY
Appeal by Applicant Appeal by Third Party
Received by: Case. No.: Appeal Filing Date:
Fee: Fee Paid Project (receipt) No.: ___________________________
Application For Appeal
Development Services
Planning Bureau
411 West Ocean Boulevard, 2nd Floor, Long Beach, CA 90802
562.570.6194