This government document is issued by City of Buellton for use in Buellton, CA
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https://www.google.com/url?client=internal-element-cse&cx=018312051982601131582:4_etvcqxw1s&q=https://www.cityofbuellton.com/files/Documents%2520%26%2520Forms%2520PD/62DC1-Request%2520for%2520Admin%2520Hearing%2520Form.pdf&sa=U&ved=2ahUKEwj1naTjnNv0AhWNlosKHW1qDtg4ChAWegQICBAB&usg=AOvVaw2npo0yOuMEXq3FyddrOPDm