Laserfiche WebLink
t ( aan Joaquin County-Public Health Services <br /> Environmental Health Division PAYMENT <br /> 304 E Weber Avenue-Third Floor-Stockton CA 95202-Phone: 209-468-3420 RECEIVED <br /> ` APPLICATION o`S JAN 14 2002 <br /> ENVIRONMENTAL HEALTH l f <br /> PERMIT TO OPERATE7ZiIeJ'AQUIN COUNIY <br /> ' EMPLOYEE HOUSING OR LABOR CAMP k9--) H`N "PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH I71VfSI0N <br /> ❑New Camp ❑ Conditional Permit Multiple Years(Permanent Housing Camps only) Annual Permit for Calendar Year 2 0 0 2 <br /> Amended Permit: 'Change of Operator 'Change of Owner <br /> I 'Change of Operator Address *Change of Owner Address <br /> I *Additional Employees <br /> Permit ID#: 0002951 <br /> Please Note any Corrections or Changes in Facility/Operator Information directly on this Camp ID#: 39000085 <br /> Site Name: SARALE FARMS INC 39-85 Location: 1 CLIFTON COURT RD,STOCKTON <br /> Operator: SARALE FARMS INC <br /> Mailing Address: PO BOX 6066, STOCKTON CA 95206 Facility Phone#:(209)943-2079 M <br /> Legal Owner: SARALE FARMS INC New Owner? Q Yes E]No <br /> I Owner Address: 16500 W CLIFTON CT,STOCKTON CA 95206 Owner Phone#:(209)943-2079 - <br /> I Community Facilities Provided by Camp: Community Kitchen: ElYeSN.0 <br /> Men: Number of Toilets 5 Number of Showers 6 Number of Lavatories 1-15(7 faucets) <br /> Women: ,lumber of Toilets �^ Number of Showers 1) _^ Number of Lavatories Q <br /> Housing Accommodations to be Utilized this Year: Occu ancv Dates: <br /> Bui dins Emnlovees from /1 +0 2 to�L/,L5/ Crop A,s p a r a g U s <br /> Dormitories 1 5— from_I_I_to—/—I—Crop <br /> SF Dwellings 30 <br /> Apartments �^ 0 Total Number of Days to be used this Calendar Year <br /> Owner Owned MH/RV —� Total Days Occupied by 25 or more Employees <br /> Owner Owned RR Cars Note: <br /> MHIRV Spaces 0 Camps occupied by 25 or more employees for 60 or more days in a year <br /> TOTALS require a Public Water System Permit. <br /> ❑ Inactive <br /> Important: In order to protect your land use status,ifcamp will not be used this year but is intended for use in the future.Check this Box and return this application. <br /> Fee Schedule <br /> `®PermanebtCanipAnfl_al-Pirmllt`Fee:°"­?'" $35.00+ Numberof:Employees .30,_ _ _,C..,St2.00each=$. 3 9 5 . 0 <br /> ❑ Orchard Camp Permit Fee: $95.00 s <br /> nn Transfer of Ownership: $20.00=5 <br /> ❑ Permit Amendment Fee: $20.00+ Number of Apional Employees @ S12.00 each=S_ <br /> I t—� Late Application Fee: $70.00+ Number of Employees @ S24.00 each <br /> Sub =s <br /> Fee must be mitted with Application <br /> TO'T'AL FEE DUE: 6 395 . 00 <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-Addressed Envelope <br /> MAKE CHECKS PAYABLE TO: PHS-EHD <br /> Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project(camp)shall be operated <br /> and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT,Chapter I,Part 1,Division 13 of the California Health <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulations. <br /> Applicant Name THOMA Title SEC/TREASURER_ _ ❑Partnership <br /> (Please PRINT or TYPE) EXCorporation <br /> Address P 0 BOX 606 Phone 209/943_2074 <br /> Applicant:Sigpa ure Date of Application 1/10/2 0 n 9 _ <br /> _ . r Amount Paid _ Date of Paymen Payment Type Check/Receipt# Received By Account ID <br /> 43 q5- �l�4 0� V �Z 5 _0002523-- - <br /> Facility ID Program Record ID WE Assigned to PWS ID <br /> 0002961 0270085 2755 2282-RABACA 0002951 <br /> Report#;7066.rpt F, 4 V D 0 Y Application Printed:11/19/01 <br />