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PETITION FOR STANDING IN CONTESTED CASE HEARING <br />(Page 1 of 2) <br />NAME: <br /> __________________________________________________________________ <br />ADDRESS: <br /> __________________________________________________________________ <br />__________________________________________________________________ <br />__________________________________________________________________ <br />PHONE NO.: <br /> __________________________________________________________________ <br />APPLICANT/ <br />DOCKET NO.: <br /> _________________________________________________________________ <br />A.Is your interest in this matter clearly distinguishable from that of the general public? <br /> Yes ___ No ___ <br /> If the answer is "yes", please explain: <br />__________________________________________________________________________ <br />__________________________________________________________________________ <br />____________________________________________________________________ <br />If the answer is "no", please explain how the proposed action will nevertheless cause you <br />actual or threatened injury: <br />__________________________________________________________________________ <br />__________________________________________________________________________ <br />____________________________________________________________________ <br />B.Are you a government agency whose jurisdiction includes the land involved in the subject <br />request? <br />Yes ___ No ___ <br />If the answer is "yes", please explain the nature of the agency's jurisdiction: <br />__________________________________________________________________________ <br />__________________________________________________________________________ <br />____________________________________________________________________ <br />C.Do you lawfully reside on or have some property interest in the land involved in the subject <br />request? <br />Yes ___ No ___ <br />If the answer is "yes", please explain: <br />__________________________________________________________________________ <br />__________________________________________________________________________ <br />_______________________________________________________________________ <br />APPENDIX A <br /> <br />