Party Request Form

CONNECTICUT SITING COUNCIL
PARTY STATUS REQUEST FORM

Docket No.    Town/City 

1.  Name: 

     Address: 

     Phone Number: 

     Fax Number: 

     E-Mail Address:  

2. Manner in which petitioner claims to be substantially and specifically affected:

           

3. Contention of the petitioner:

            

4. Relief sought by the petitioner:

            

5. Statutory or other authority therefore; and 
            
            

6. Nature of evidence of evidence that the petitioner intends to present.

            

7. Copies of this request shall be mailed to all participants at least five days before the 
    date of the hearing.

Signed ________________________________ Date ___________________