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Get ND SFN 19145 2005

TA DEPARTMENT OF HEALTH DIVISION OF WATER QUALITY Application No. SFN 19145 (2/05) GENERAL INFORMATION Name of Owner of Construction Project Contact Person Name Contact Phone No. Mailing Address City State Zip Code Type of Owner Developer/Builder General Contractor Municipality or Operator State of ND Federal Other (Specify): This NOI is to obtain coverage under Small Construction Activity (see Part I.D of permit): Name of Construction Project (Large Construction Activity Only).

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