PERMFILE72578

• Permit No: M1978143
• IBM Index Class Name: Permit File
• Doc Date: 4/27/1978
• Doc Name: LIMITED IMPACT AND SPECIAL PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

i
NOTICE PROCEDUP.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
followed.
ADDITIOiIAL, I.;FOiL'~ATIO:I
This space can be referenced for further information of any of the items
on this form.
To the best of my ivZO:7ledge, all the infoz-~~tion presented in th'_s app L-'catica
is true and correct.
Sy: ~oD ~' ~ rv~,
Title:
(Signed by individual legzl'_y aut'r.or:2ed
to bind the operatcr to this 3pD11CatiO n)
t:f