PERMFILE55501

• Permit No: M1977459
• IBM Index Class Name: Permit File
• Doc Date: 10/19/1977
• Doc Name: LIMITED IMPACT & SPECIAL TEN DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

PiOTICE FROCEDUf'.ES
After the application has been filed with the Division, notice pro-
cedures outlined in Section 3.2 or 4.2 (whichever is applicable) must be
followad.
ADDITIONAL L`:rOP.2li.TI0i~
This space can be referenced for further infor;~ation of any of the ite.~s
on this force.

To the best of my knoealedge, all the information presented in this application
is true and correct.

y; i
~---. _
-
Title: ~~/l"P C~ Go.-t_~ s1-•~~~~
(Signed by individual legally authorized
to bind the operator to this application}