PERMFILE105946

• Permit No: M1978002
• IBM Index Class Name: Permit File
• Doc Date: 1/3/1978
• Doc Name: LIMITED IMPACT & SPECIAL 10-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 INFORMATION
This apace can be referenced for further information of any of the items
on this form.
SW;iNW~iSE~ Sar In T7A, Rln4w ~6 th PM
To the best of my knowledge, all the information presented in this application
is true and correct.
ey:
Title:
(Signed by individual legally authorized
to bind [he opecator to this application)