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Rule 14-96, F.A.C. 850.040.18 SYSTEMS PLANNING - 06/06 Page 3 of 3 I PARTS: SPECIAL PROVISIONS I NON -CONFORMING CONNECTIONS: [] YES '0 NO If this is a non -conforming connection permit, as defined in Rule Chapters 14-96 and 14-97, then the following shall be a part of this permit. 1. The non -conforming connection(s) described in this permit is (are) not permitted for traffic volumes exceeding the Permit Category on page 1 of this permit, or as specified in "Other Special Provisions" below. 2. All non -conforming connections will be subject to closure or relocation when reasonable access becomes available in the future. Nit OWI#�13T-03L•l_11111:Z9P1N101'l,�i I PART 6: APPEAL PROCEDURES I You may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. If you dispute the facts stated in the foregoing Notice of Intended Department Action (hereinafter Notice), you may petition for a formal administrative hearing pursuant to section 120.57 (1), Florida Statutes. If you agree with the fads stated in the Notice, you may petition for an informal administrative hearing pursuant to section 120.57(2), Florida Statutes. You must file the petition with: Clerk of Agency Proceedings Department of Transportation Haydon Bums Building 605 Suwannee Street, M.S. 58 Tallahassee, Florida 32399-0458 The petition for an administrative hearing must conform to the requirements of Rule 28-106.201(2) or Rule 28-106.301(2), Florida Administrative Code, and be filed with the Clerk of Agency Proceedings by 5:00 p.m. no later than 21 days after you received the Notice. The petition must include a copy of the Notice, be legible, on 8 1/2 by 11 inch white paper, and contain: 1. Your name, address, telephone number, any Department of Transportation identifying number on the Notice, if known, the name and identification number of each agency affected, if known, and the name, address, and telephone number of your representative, if any, which shall be the address for service purposes during the course of the proceeding. 2. An explanation of how your substantial interests will be affected by the action described in the Notice; 3. A statement of when and how you received the Notice; 4. A statement of all disputed issues of material fact. If there are none, you must so indicate; 5. A concise statement of the ultimate facts alleged, including the specific facts you contend warrant reversal or modification of the agency's proposed action, as well as an explanation of how the alleged fads relate to the specific rules and statutes you contend require reversal or modification of the agencys proposed action; 6. A statement of the relief sought, stating precisely the desired action you wish the agency to take in respect to the agency's proposed action. If there are disputed issues of material fad a formal hearing will be held, where you may present evidence and argument on all issues involved and conduct cross-examination. If there are no disputed issues of material fad an informal hearing will be held, where you may present evidence or a written statement for consideration by the Department. Mediation, pursuant to section 120.573, Florida Statutes, may be available if agreed to by all parties, and on such terms as may be agreed upon by all parties. The right to an adminstrative hearing is not affected when mediation does not result in a settlement. Your petition for an administrative hearing shall be dismissed ff it is not in substantial compliance with the above requireme4nts f 'Pie W-106-201(2) or Rule 28-106.301(2), Florida Administrative Code. If you fail to timely file your petition in accordance with the a w�uitemets y ' I lhave waived your right to have the intended action reviewed pursuant to chapter 120, Florida Statutes, and the action for h en h 6(i� aall e conclusive and final. K & ,-., - a E - --1 5/8/2018 ..