Section 811.14.6. Content of petition.

A petition for waiver shall include the following information where applicable and known to the requester:

        1.            The name, address, and telephone number of the entity or person for whom a waiver is being requested and the case number of any related contested case.

        2.            A description and citation of the specific rule from which a waiver is requested.

        3.            The specific waiver requested, including the precise scope and duration.

        4.            The relevant facts that the petitioner believes would justify a waiver under each of the four criteria described in rule 811—14.4(17A,169). This statement shall include a signed statement from the petitioner attesting to the accuracy of the facts provided in the petition and a statement of reasons that the petitioner believes will justify a waiver.

        5.            A history of any prior contacts between the board and the petitioner relating to the regulated activity or credential affected by the proposed waiver, including a description of each affected credential held by the requester, any notices of violation, contested case hearings, or investigative reports relating to the regulated activity or credential within the last five years.

        6.            Any information known to the requester regarding the board’s treatment of similar cases.

        7.            The name, address, and telephone number of any public agency or political subdivision which also regulates the activity in question or which might be affected by the granting of a waiver.

        8.            The name, address, and telephone number of any person or entity that would be adversely affected by the granting of a petition.

        9.            The name, address, and telephone number of any person with knowledge of the relevant facts relating to the proposed waiver.

        10.           Signed releases of information authorizing persons with knowledge regarding the request to furnish the board with information relevant to the waiver.