HOUSING BOARD OF ADJUSTMENTS AND APPEALS
CITY-COUNTY GOVERNMENT OFFICE BUILDING
SALISBURY, MARYLAND


TO: Housing Board of Adjustments & Appeals

FROM: Director, Department of Neighborhood Services & Code Compliance

DATE :

                    In accordance with Article X, Sec. 15.24.390 of the City of Salisbury Property Maintenance Code, Ordinance No. 1665, I hereby request a hearing before the Salisbury Housing Board of Adjustments and Appeals to consider my appeal from the City's Building Official.

                    In making my appeal, the following information is hereby provided:


1) Appeal of : Phone # :
                              Name

 

   Address :
                           Street                                     City                     State            Zip


The following names and addresses of all appellants who will participate in the appeal:
          A. Name Phone # :
               Address :
                                  Street                                     City                     State            Zip

          B. Name Phone # :
               Address :
                                  Street                                     City                     State            Zip

          C. Attorney Representing Applicant:
               Name Phone # :
               Address :
                                  Street                                     City                     State            Zip

2) The following is a brief statement setting forth my legal interest and of the other appellants in the building or the land involved in the notice and order dated ; relative to the premises located at

3) The following is a brief statement in ordinary and concise language of the specific order or action protested, together with any material facts claimed to support the contentions of the appellant.

4) The following is a brief statement in ordinary and concise language of the relief being sought, and the reasons why it is claimed the protested order or action should be reversed, modified, or otherwise set aside.

5) The following are signatures of all parties named as appellants, and their official mailing address and phone number:
          Name Phone # :
          Address :
                             Street                                     City                     State            Zip

          Name Phone # :
          Address :
                             Street                                     City                     State            Zip

          Name Phone # :
          Address :
                             Street                                     City                     State            Zip

I, (we), hereby declare and certify under penalty of perjury that the above statements are true as stated herein.

 

 

  Electronic Signature Date

 


 
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