Notice is hereby filed for an appeal of the decision of/action of _____
in regards to___________ on the grounds that _____
_____
_____
_____
_____ .

Appellant's Signature _____

Agent's Signature _____

Date of Hearing of the appeal of the Britton Planning and Zoning Commission

_____

Britton Planning and Zoning Commission—Action _____
_____
_____ .