PERMFILE106446

• Permit No: M1977098
• IBM Index Class Name: Permit File
• Doc Date: 6/10/1977
• Doc Name: LIMITED IMPACT AND SPECIAL TEN DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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NOTICE PROCEDURES
After tl~e 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 space can be referenced for further information of any of the items
on this form.
To the best of my knocrledge, all the information presented in this application
is true and correct.
sy:
Title: ~,~, ,~ - ~,
(Signed by individual legally authorized
to bind the operator to thla application)