2003-2004 - MCWD erosion control permit

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JUL-16-2004 10 52 P.03/04 Existing owner information: For the purposes r-.f r is form the" ".ring owner"will refer Thy erson or party wishing to transfer the permit. Name(last, ftrst, MI) G• J"1/ Comp„Name(if applicable) 'ie..�.c,,l !�/��l Uk • ��J 0/ ,w, Pr - Address (Street, RFD, Box#, City State.Zip) _ cam- Cc , Phone Number(include arca code)/Email Address(if avail. ,le)/Fax.Number(if available) 2. The following information must be given to the New Owner for review prior to permit transfer application: • Copy of the MCWD approved erosion control plan under the existing permit. • MCWD-supplied Fact sheet on Sediment and Erosion Control. 3. All approved/required erosion and sediment control measures indicated on the MCWD approved erosion control plan must be installed and functioning according to MCWD approved standards prior to permit transfer application. 4. I understand that permit transfer is not complete until the new owner has received a permit,and that until such time that permit tjansfer is complete, I am the party responsible for implementing and following the conditions of the permit. /l[.1 tnical 5. I understand that submission of this application does not guarantee permit transfer and more information may be requested. I hereby certify that to the best of my knowledge and belief all information contained in this document and accompanying attachments are true,complete,and accurate. i am aware that there are significant penalties for submittin else i prmati 6-- 21' 0 Exi Own kens Date For Office Use Only Approved By: Title: District Technician, Date of Issuance: Date of E piration: Based on Plans Received on: Conditions • The'permit holder is respdmsi ile for;corn liance With all.MCWD Rules and for the action(s)of their representatives,, pontradtors,and employees, • All erosion and sediment control measures must be effectively installed and maintained according to MCWD guidelines as laid out by current I3istrict Rules artd.Policies until all disturbed soils are peri»atnently stabilized- ' • • All temporary erosion and sediment control measures must be removed following final inspection by MCWD Staff after all disturbed soils have been permanently stabilized. • District staff or their representatives may enter lots for the purposes of enforcing and determining compliance with District Rules. • MCWD may charge fees folr actual time for inspections,legal services, monitoring,analysis, and any supporting work according to the current MCWD Fee Schedule which may be subject to change. • Page 2 of 2 rr? QgWnk 111HSNR S 89STSPOZS6 Sb=0I b00Z/90/LB