Laserfiche WebLink
'l PA220015. 8 <br /> SAN JOAQUIN Environmental Health Department <br /> ---COUNTY-- <br /> i <br /> GrPti-ne- 7r-i s he e. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: <br /> Facility Address: 645 Yettner Road French Camp, CA. 95231 <br /> Street City tip <br /> Facility Business Owner Name: Gurpartap Singh Phone: 209-814-5739 <br /> Property Owner Name: Gurpartap Singh Phone: 209-814-5739 <br /> Property owner Address: 62 North Sierra Madre Street Mountain House 95391 <br /> Street CTs, Zip <br /> WATER PROVISION INFORMATION <br /> 1. Number of houses, mobile homes, or other occupied buildings served by the water well(s):0 <br /> 2. Number of employees at the facility per shift: 0 Number of shifts: 1 <br /> 3. To tal number of employees, customers, and visitors at the facility per month, if variable: <br /> January Aprll _ - <br /> July October <br /> February -- <br /> May August November <br /> March June September December <br /> i <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January 20 Aprll20 July 20 October 120 <br /> February 20 120 August 20 November 20 <br /> March 20 June 120 September 20 _ December 20 <br /> 5. Number of yearlong residents: n/a <br /> 6. Number of residents per month, if variable: <br /> January Na April Jul _ 1 October_ <br /> February May --- -— -August November <br /> March June September December <br /> I declare under penalty of perjury that the statements on this application are correct to my knowledge. It is the <br /> o;wner's responsibility to notify this office if the water provision information of the facility changes. <br /> Facility business/Property Owner: M Date: ' Z`2�o2L <br /> Signature <br /> 18681 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 .F 209 464-0138 1 www.sjcehd.com <br />