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Identification Of Potentially Affected Parties 49456 - Indiana
| Identification Of Potentially Affected Parties Form. This is a Indiana form and can be used in Water Department Of Enviromental Management Statewide . |
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Identification of Potentially Affected Parties State Form 49456 (7-99) Indiana Department of Environmental Management Office of Water Management, Permits Section The Administrative Orders and Procedures Act (AOPA) IC 4-21.5-3-5(b), requires that the Indiana Department of Environmental Management (IDEM) give notice of its decision on your application to the following persons: (a) (b) (c) each person to whom the decision is specifically directed; each person to whom a law requires notice to be given; each competitor who has applied to the IDEM for a mutually exclusive license, if issuance is the subject of the decision and the competitor's application has not been denied in an order for which all rights to judicial review have been waived or exhausted; each person who has provided the IDEM with a written request for notification of the decision; each person who has a substantial and direct proprietary interest in the issuance of the (permit/variance); each person whose absence as a party in the proceeding concerning the (permit/variance) decision would deny another party complete relief in the proceeding or who claims an interest related to the issuance of the (permit/variance) and is so situated that the disposition of the matter, in the person's absence may: (1) (2) as a practical matter impair or impede the person's ability to protect that interest, or leave any other person who is a party to a proceeding concerning the permit subject to a substantial risk of incurring multiple or otherwise inconsistent obligations by reason of the person's claimed interest. (d) (e) (f) IC 4-21.5-3-5(f) provides that we may request your assistance in identifying these people. Our failure to properly identify and notify these people of the decision could have the result of voiding any decision which is made. Additionally, IC 13-15-3-1 requires IDEM to send notice that the permit application has been received by the department to the following: (a) (b) (c) the board of county commissioners of a county affected by the permit application and the mayor of a city that is affected by the permit application, or the president of a town council of a town affected by the permit application. Please provide on the attached form the names of those persons affected by these statutes. American LegalNet, Inc. www.FormsWorkflow.com I. Identification of Potentially Affected Persons Please list here any and all persons whom you have reason to believe have a substantial or proprietary interest in this matter, or could otherwise be considered to be potentially affected under the law. Failure to notify any person who is later determined to be potentially affected could result in voiding our decision on procedural grounds. To ensure conformance with AOPA and to avoid reversal of a decision, please list all such parties. The letter attached to this form will further explain the requirements under the AOPA. Attach additional names and addresses on a separate sheet of paper, as needed. Please indicate below the type of action you are requesting. Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: Name: Street: City/State/Zip: II. Please complete this form by signing the following statement. I certify to the best of my knowledge I have listed all potentially affected parties, as defined by IC 4-21.5. Signature: Facility Name: Facility Address: Printed name: Date: III. Type of Action (check one) Return To: Indiana Department of Environmental Management 9 9 9 9 NPDES PERMIT - 327 IAC 5 PRETREATMENT PERMIT - 327 IAC 5 SEWER BAN WAIVER REQUEST - 327 IAC 4 CONSTRUCTION PERMIT - 327 IAC 3 Office of Water Management 100 North Senate Avenue P.O. Box 6015 Indianapolis, Indiana, 46206-6015 American LegalNet, Inc. www.FormsWorkflow.com
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