Form Dsss 41 - Application For Swim Line Permit - Department Of Safety - New Hampshire Page 4
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4FOR OFFICIAL USE ONLY:
Applicant:
Body of Water:
1. Field investigation notes:
2. Approval status recommendation:
Approve as submitted.
Approve with the same conditions as prior years:
Approve with the following conditions:
Deny: Please provide reason for recommendation of denial.
Signed:
Date:
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