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050-04046 sySnEM$FtMMW_zM PART 6- SPECIAL PROVISIONS NON-CONFORMINGCONNECTIONS. 0 YES Q. NO If -this is a non-conf6tming connection permit, at defined, In Rule Chapters 14-96-aftd 1497 Then the following Shall bea part of this permit 1, The non -conforming connection(s) clescribed' in this,permit is -(are) not permitted for "Mr -volumes exceeding the Permit Category on . page I oft , his permit, or as specified I in "Other tiedal Pt6visions"below 2 All nonformingconnections YOU be subject to dosureor relocation when reasonable access becomes available in the future OTHER.$PECIAL PROVISIONS: PART 0:. APPEAL PROCEDURES .You y mapetition for an adaikiatrative hearing.pursuant to sections 120.569 and 120.57, Florida, Statutes. If you dispute: the facts stated in the. foregoing.I 'N Ofte Oftntended 'Departmen 1. t Adsonftreirtaftwr Notice)'. you may petition for a formai . . administrative hearing purstntnt 10 section 120.57(1), Florida: SMftS- If you agree with the 11act9stated in the Notice you :may petition furan informal adninstiatiV6 hearing.PUrs-danttoi. section 120 57(2) "Florida Statutes You must file the petition with-.' Perk. of Agency Proceedtngs Depattymnt of Transportation. Haydon Sums Building 605 SuwanneeStree , � M.S. 58- Tallahass6e Florida 32399-0458. The petition for M ad6fistratve heartng must conforn; to the requftmerh of Rule 28-1062DI(2),Or RtAe26:10630IJ2)..FlorWa-AdrdnWtTAtive -Gode,-and,befledvft-the-,Uerk:df Agency Ptooeodings�b�5-00*0.m-holkterftn2l-d4s-.afti*,DuTecenfed,.I*-Notica:Ttidot0t)ihhiust Include a oopy.of the'Nofice be legibik on4l* by It *fi wt*6paper and contain: Your name,. ddress, Wephorig rAirnber. MV Dep4ttment of Tr4rmportation klerfflfft nurjhber an the Notice, TWoWn the hanle and identiftation hurnb6r-of Each agency jff6ded,,jfkn6An:and the namb-Addire-mr, and telephone number of your repreientaM if any d ng,the.wWse pri of thotprooeedirig -An explangon of how your substgntiol interestsYnlI be affected by the action clesow In (64 Notim.- e. A Vlatament of when and how you received the Notiq � 4 A statement of all disputed issues of material fact, If there -am none you inust so indicate, 5 A concise statement ofthe ulftate facts aleged.Andading the specific facts you contend warrantsev&Ysid orrhodification of the agerWt,proodsed, action, as well as an bkplaharjon of how the alleged facts Mate t6thd.specifid-rules and stwesyqu contend I -eVIers . � Al require-r.or modification of the, 4gency!sproposed action; 6 Azteternent df.ft relief sought stating piecis* the desired action you wish the agency 15D take in respect to the agency's proposed atsion Ifftre are disputed Ls_ -Am of material fact a foftaVbeafing will be hdd, Where.ybd may ptesetit _,MWoe,.dmd.,arqurnen1-,6n aR issuesinvolved and conduct sass -examination If there are no disputed issues of Materialwfact an infaimat'heafirg.vAl be held where you may present evidence or avritt.an statement Wponsideration by1he Department MecroffoR pursuant to section 120,673, Mode Statutes, may be evallable if agreed to by all parties: and on wich-temi os may be agreed upon 'by all patties The right to an adrninstratiVe hewing is n6tafect@d Wtien mediation does not result in arsetflement Your petition for an,administra9ve hearing shall be dismissed if It isnot in substantial compliance with the above requirements of Rule 20A65201(2) nr]Rute28-106.301(2), Florida AdffdnM-dbM Code if -you fail to tirnety-fte your petition InM 6CDOance with the above, requiirarnents,you.Will have waived your right to have the intandedactiorf reviewed pursuant to chapter 120 Florida . St allet and t . head I lo4se t forth In tho Ndfioe shal be condusive and final a '' __ __ - - I 2018-A-419'0-010 Mesa Nesa Harden 5/00/2018