PERMFILE106635

• Permit No: M1977485
• IBM Index Class Name: Permit File
• Doc Date: 10/3/1977
• Doc Name: LIMITED IMPACT & SPECIAL 10 DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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NOTICE PROCEDU£.ES
After [he 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
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This space can be referenced for further information of any of the i[ems
on this form.
To the best of my knowledge, all the information presented in this application
is true and correct.
BY ~ V//1,~i1~~~~~IG ~.,./
Title: ~_~. ~ [a->m .-
(Signed by individual legally authorized
to bind the operator [o thfs application)