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APPLICATION FOR APPEAL RENTAL HOUSING PRESERVATION APPEALS COMMITTEE A.M.C. SECTION 15.70.140 I, , was issued one or more of the following notices: (PRINT NAME) ☐Notice of Intent to Inspect; ☐Notice of Violation & Order to Comply; ☐Civil Citation and/or Re-inspection Fee(s), dated relating to the property at the following address or location as specified on said notice(s): , Anaheim, California. This application for appeal is filed to contest the following violations as alleged in said notice(s): Check applicable box: ☐All ☐The following alleged violation(s) only: Pursuant to Section 15.70.140 of the Anaheim Municipal Code, I hereby contest said alleged violation(s) above identified on the following grounds: Check all applicable boxes: ☐(1)The violation(s) alleged in said notice(s) did not occur; ☐(2)The violation(s) alleged in said notice(s) (was) (were) corrected within the correction period specified on said notice(s); ☐(3)I am not a responsible person for the violation(s) as such term is defined in Section 15.70.030 of the Anaheim Municipal Code; ☐(4)Circumstances do not warrant imposition of the fine(s)/fee(s) prescribed. If this application relates to more than one alleged violation and you are contesting the violations on different grounds, please indicate which of the above grounds (by number) apply to each alleged violation contested: Date: Signature: Mail Address: COD - Telephone: Note: This application must be received by the Code Enforcement Office no later than thirty (30) days following the date of said notice(s) and must be accompanied by either a deposist of the fine amount(s) specified in the Civil Citation, or a separate application for waiver of the advace deposit if you do not have the financial ability to make the deposit. You will be notified of the time and place of the hearing regarding this application. If the hearing results in a decision in your favor, the amount of your deposit will be refunded in accordance with the decision. FAILURE TO SUBMIT THE FINE DEPOSIT OR WAIVE APPLICATION WILL RESULT IN AN ABANDONMENT OF YOUR CONTEST AND AFFECT YOUR LEGAL RIGHTS TO FURTHER CHALLENGE THE SAID NOTICE(S) - SEE REVERSE SIDE - SIGN