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REQUEST FOR PERMIT <br />EXTENSION ! REFUND <br /> <br />APPLICANT'S NAME: ~ <br />APPLICANT'S MAILING ADDRESS: C~ OO ~ ~q-, 9~o L- ~ ¥ <br />PLEASE CHECK .~_~EX~ENSiON OR ~FUND <br /> <br />ACT~ NUMBER: ~ - ~ ~ I <br /> <br />TELEPHONE: /_,. ~B ~' ~ '~-/~ '~-~, <br /> <br />REASON PROJECT lqOT COMPLETED BY EXPIRATION DATE: <br /> <br />EXPECTED TIME FOR COMPLETION: <br /> <br />PLEASE ALLOW $ BUSINESS DAYS TO PROCESS EXTENSION REQUESTS AND <br />ALLOW UP TO 3 WEEKS TO PROCESS REFUNDS. <br /> <br /> <br />