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(J BHAI.LNOTEMPLOYAHYPEt1SONWMIYMFNNER90ASTaBECOMESI�.IECTTOTNE - � � yypqKERS ppNpENSATION IAWe OF CAL�ORNIA,AND A(iPEE Twli IF I SHOUID BECOh1E SPECTION FEE � ....._._ . _ SlSJE4TTOTF�WOWCERSWYPENeAT10NPROY15lON50F5ECT10N3m00FTHEtABON .. . � S _ _ _ _ 000E.�stwi.wannnn�caaw.rwmr niose aarnnsbru. ISSUM7CE --- l 0 _ .�SMIP _.-___ M �n ATZ - - p �Wl7E .... ._.. ---�__APPL�cutP.... __. . ___. .... . .... . . . .. . t-a�+� W�FALUiIE TO SEWRE WORKEIiS COMPENSAiION COVERMiE IS uPAAM/FUt,MID&iM1 BE .... ENERCaY P/C �.. ..� �.��_� -� �Tu+aaa�c�vEarocaiwuw_v�s�su�nav�Fu+�suaraoxEwwor�nnausu�o ..._. ENEH6YPERMIT ` �� - pOU,Afi4(ttao.ouo�.MADDRiON TO7HE COST OF COMPENSATION.�AMA6ES AS PHOVIDEO FON W � � , �, J SECTION77U60FTHEGBOROODE.NiEHES.ANDAT70RNE'/'5FEE5. NETENT�ONFEE: . .. _ _ . ._., e - -I - . ._._ .� . . .. . . . . . .... .. . .. . .. ...._ _. _.. . ... . ........ . . 4 CONS�RUCTION LENDMIG AGENCY PRE-ALT FE � - � IHEREBY/1FFlHNlMDEHPENN.7Y�PERJURY7HATh�RE19ACON87RUCT10NLENDIN6A�ENCY ._ PoRTHE VERPDRAIANCE OFTHE WOF1C WN WHIQI THIS PERMIT IS ISSUED(SEC.3077.CIV.G} . . - Z _ '�^� . , ' W . � ����E . .... . . . -. . . . .. .._. . _... . .. -' -' -. . � IEPoDEH'8A0011E68 .. . _� icefmr-rnuaiwwe�on��s�rauG,r�iwosT��rw�rr�eeovEx�cow.uTarrisco�wEcr. TOTAL FEES _��C�i � d IAOFiEE7000MPLYWIIHILLCffYN1DCOUNTYWWIWWCESANOSTATELAWSFEUTWOT08UYDINO . . . . .- '... .COHSTNUCi�ON.ANDF1EFEeYAIfIHDR2EHEPFiESEMATIVESOFIHISC9UNTlTOENTEflUFONAIE_ .. . .. ..., .. . . . _.._ � . � � � �eovE�rtror�o Fon qisPEcrpr�nua COMMENTS _ 9 __ _ __ _. _. , ° � - _ _ _ , ,.;,. m ��� � _a _ _ ... . ep _. . . . � � p�TE qECPT.NO. PAID BY VACJDATIbN. � � .- . _ -_. . ...._ ..._...�- -.._._ ..... _.__.. .. . . .. .. . . . . . . ��. . . . " ,. 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