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DEP vs. Indian River County <br />Settlement Agreement, OGC No. 22-0150 <br />Page 10 <br />b) The name, address, any e-mail address, any facsimile number, and telephone <br />number of the petitioner, if the petitioner is not represented by an attorney or <br />a qualified representative; the name, address, and telephone number of the <br />petitioner's representative, if any, which shall be the address for service <br />purposes during the course of the proceeding; and an explanation of how the <br />petitioner's substantial interests will be affected by the agency determination; <br />c) A statement of when and how the petitioner received notice of the agency <br />decision; <br />d) A statement of all disputed issues of material fact. If there are none, the <br />petition must so indicate; <br />e) A concise statement of the ultimate facts alleged, including the specific facts <br />the petitioner contends warrant reversal or modification of the agency's <br />proposed action; <br />f) A statement of the specific rules or statutes the petitioner contends require <br />reversal or modification of the agency's proposed action, including an <br />explanation of how the alleged facts relate to the specific rules or statutes; and <br />g) A statement of the relief sought by the petitioner, stating precisely the action <br />petitioner wishes the agency to take with respect to the agency's proposed <br />action. <br />The petition must be filed received at the Department's Office of General <br />Counsel, 3900 Commonwealth Boulevard, MS# 35, Tallahassee, Florida 32399-3000 or <br />received via electronic correspondence at Agency_Clerk@floridadep.gov, within 21 <br />days of receipt of this notice. A copy of the petition must also be mailed at the time of <br />filing to the District Office at Southeast District Office 3301 Gun Club Road, MSC 7210-1 <br />West Palm Beach, FL 33406. Failure to file a petition within the 21 -day period <br />