W. Va. Code R. agency 49, tit. 49, ser. 49-01, app 1

Current through Register Vol. XLI, No. 50, December 13, 2024

Appendix 1 - WEST VIRGINIA SURFACE MINE BOARD CHARLESTON, WEST VIRGINIA

_________________________,

APPELLANT'S NAME,

Appellant,

v. Appeal No.

DIRECTOR, DIVISION OF

________________________,

DEPARTMENT OF

ENVIRONMENTAL PROTECTION,

Appellee.

NOTICE OF APPEAL

Action Complained Of: The appellant(s) named above respectfully represent(s) that it is aggrieved by: (describe the order, failure or refusal, or permit, and give date of the order or permit):

Relief Requested: The appellant(s) therefore pray(s) that this matter be reviewed and that the Board grant the following relief (describe the relief sought):

Specific Objections: The specific objections to the action, including questions of fact and law to be determined by the Board, are set forth in detail in separate numbered paragraphs and attached hereto. The objections may be factual or legal.

Dated this _____ day of ______________, 20 ______.

___________________________________

(Signature)

___________________________________

(Address)

___________________________________

___________________________________

(Telephone)

^[1] This form is offered as guidance to unrepresented parties.

W. Va. Code R. agency 49, tit. 49, ser. 49-01, app 1