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I <br /> PETITION FOR STANDING IN A CONTESTED CASE HEARING <br /> (Page 1 of 2) <br /> r` <br /> NAME: ' <br /> ADDRESS: <br /> PHONE NO.: �'7'/ R,✓ 3 1�2 /2 k ✓e-ew/- .;�3/4 -rf ,- <br /> APPLICANT/ <br /> DOCKET NO.: <br /> A. Is your interest in this matter clearly distinguishable from that of the general public? <br /> Yes 1/ No <br /> If the answer is "yes",please explain: <br /> If the answer is"no", please explain how the proposed action will nevertheless cause you <br /> actual or threatened injury: <br /> B. Are you a government agency whose jurisdiction includes the land involved in the <br /> subject request? <br /> Yes No <br /> If the answer is "yes", please explain the nature of the agency's jurisdiction: <br /> C. Do you lawfully reside on or have some property interest in the land involved in the <br /> subject request? <br /> Yes No <br /> ��. <br /> If the answer is "yes", please explain: <br /> Appendix A <br />