PERMFILE125072

• Permit No: M1977322
• IBM Index Class Name: Permit File
• Doc Date: 9/30/1977
• Doc Name: LIMITED IMPACT AND SPECIAL TEN DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

,..-' • •
170TICE PROC'cDtiRES
After the application has been filed wit'.t the Division, notice pro-
cedures outlined in Section 3.2 or 4.2 (whichever is applicable) must be
followed.
ADDITIONAL I:IeOR*1~1TIO.d
-3-
This space can be referenced for further informaCion of any of the items
on this form.
To the best of my k;,o~sled~e, all the inforr^ation presented in this application
is true and correct.
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Title: ~ ~ ~
(Si ed by individual legally authorized
to o ~ this application)
Prepared by:
R. Stephen Schermerhorn, P.E.
President
IMPACT Environmental Consultants