PERMFILE65962

• Permit No: M1980019
• IBM Index Class Name: Permit File
• Doc Date: 12/3/1980
• Doc Name: LIMITED IMPACT AND SPECIAL TEN DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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' NOTICE PROCEDURES
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
followed.
ADDITIONAL INFOR*fATION
This space can be referenced for further information of any of the items
on this form.
~i
To the best of my knocrledge, all the information presented in this applicat:
is true and correct.
By : .~j,1
Title: i
(Signed by iadivid'ual legally authorize
to bind the operator to this apolieaci~