Get HI DLNR APO-11

DLNR s contested case hearing rules are listed under Chapter 13-1 HAR and can be obtained from the DLNR Administrative Proceedings Office or at its website http //hawaii. gov/dlnr/rules/Ch13-1Official-Rules. pdf. Please review these rules before filing a petition. 3. If you use the electronic version of this form note that the boxes are expandable to fit in your statements. File deliver mail or fax this form within ten 10 days of the Board action date to Department of Land and Natural Resources Administrative Proceedings Office 1151 Punchbowl Street Room 130 Honolulu Hawaii 96813 Phone 808 587-1496 Fax 808 587-0390 2. DLNR s contested case hearing rules are listed under Chapter 13-1 HAR and can be obtained from the DLNR Administrative Proceedings Office or at its website http //hawaii. STATE OF HAWAII BOARD OF LAND AND NATURAL RESOURCES PETITION FOR A CONTESTED CASE HEARING OFFICIAL USE ONLY Date Received Case No* Board Action Date / Item No* Division/Office INSTRUCTIONS 1. File deliver mail or fax this form within ten 10 days of the Board action date to Department of Land and Natural Resources Administrative Proceedings Office 1151 Punchbowl Street Room 130 Honolulu Hawaii 96813 Phone 808 587-1496 Fax 808 587-0390 2. DLNR s contested case hearing rules are listed under Chapter 13-1 HAR and can be obtained from the DLNR Administrative Proceedings Office or at its website http //hawaii. gov/dlnr/rules/Ch13-1Official-Rules. pdf. Please review these rules before filing a petition* 3. If you use the electronic version of this form note that the boxes are expandable to fit in your statements. If you use the hardcopy form and need more space you may attach additional sheets. 4. Pursuant to 13-1-30 HAR a petition that involves a Conservation District Use Permit must be accompanied with a 100. 00 non-refundable filing fee payable to DLNR or a request for waiver of this fee. A waiver may be granted by the Chairperson based on a petitioner s financial hardship* 1. Name A. PETITIONER If there are multiple petitioners use one form for each. 2. Contact Person 3. Address 4. City 5. State and ZIP 6. Email 7. Phone 8. Fax 9. Attorney Name B. ATTORNEY if represented 10. Firm Name 12. City 14. Email 15. Phone 16. Fax FORM APO-11 Page 1 of 2 C. SUBJECT MATTER 17. Board Action Being Contested 19. Item No* 20. Nature and Extent of Petitioner s Interest That May Be Affected by the Board Action 21. Any Disagreement Petitioner May Have with an Application before the Board 22. Any Relief Petitioner Seeks or Deems Itself Entitled to 23. How Petitioner s Participation in the Proceeding Would Serve the Public Interest 24. Any Other Information That May Assist the Board in Determining Whether Petitioner Meets the Criteria to Be a Party under Section 13-1-31 HAR Check this box if Petitioner is submitting supporting documents with this form* Petitioner or Representative Print Name Signature Date. STATE OF HAWAII BOARD OF LAND AND NATURAL RESOURCES PETITION FOR A CONTESTED CASE HEARING OFFICIAL USE ONLY Date Received Case No* Board Action Date / Item No* Division/Office INSTRUCTIONS 1. File deliver mail or fax this form within ten 10 days of the Board action date to Department of Land and Natural Resources Administrative Proceedings Office 1151 Punchbowl Street Room 130 Honolulu Hawaii 96813 Phone 808 587-1496 Fax 808 587-0390 2. .