PERMFILE119018

• Permit No: M1984041
• IBM Index Class Name: Permit File
• Doc Date: 2/23/1984
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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ADUITIUNAL INFORMATION
Tnis space can be referenced for further information of any of the items in this form.
Enclosed with this application is a copy of our Eagle Count
Special Use Permit application. Forwarded for yn„r lnfnrm~t;.,+,
Department of Health permit approvals data will be forwarded
as received.
To the best of my knowledge, all the information presentee in this application is true
and correct.
~ ~
Uate: , By:
E Tinley
General Partner, R
it e
(Signature by individual legally authorized to
bind the operator to this application)
(Rev. y/33)
Uoc. No. 5547