PERMFILE101852

• Permit No: M1978305
• IBM Index Class Name: Permit File
• Doc Date: 9/25/1978
• Doc Name: LIMITED IMPACT AND SPECIAL TEN DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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NOTICE PROCEDD'KES _"-
After the application has been filed with Cha Division, notice pro-
cedures outlsad is Section 3.2 or 4.2 (whichever is applicable) must be
followed.
ADDITIONAL INFOR*lATZON
This space can ba referenced for further information of any of the items
on this form,.
To cha beat of mq knowledge, all the iaformatio¢ presented is this appllcation
is true and correct.
- - - ~r
By~ y n~~
Title:
(Signed by individual legally authorized
to bind the operator Co this application)