PERMFILE43499

• Permit No: M1977311
• IBM Index Class Name: Permit File
• Doc Date: 9/30/1977
• Doc Name: LIMITED IMPACT & SPECIAL TEN-DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

NOTICE PROCEDURES
After the application has been filed with the Division, notice
procedures outlined in Section 3.2 or 4.2 (whichever is applicable)
• must be followed.
ADDITIONAL INFORMATION
• -_
This space can be referenced for further information of any of
the items on this form.
To the best of my knowledge, all the information presented in this
application is true and correct.
Date : ~„gp~7~
BY ~ ~~
Title : ,OSSf ~ c -~'rsiC~Pn~
(Signed by individual legally
authorized to bind the operator
to this application)