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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> For Calendar Year `] NOV 0 8 1996 OFFICE USE ONLY <br /> Area <br /> Multiple Years (Permanent Housing Camps) APPLICATION <br /> Conditional ermit l Date Approved <br /> I.D. No. � ` (For Non-Transferable, Revocable, Suspendable) <br /> Permit <br /> ENVIRONMENTAL HEALTH PERMIT <br /> Date Mailed <br /> TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP New Existing <br /> FEE IS DUE WITH APPLICATION Change <br /> Location CP 21 Henning Tract, McDonald Island <br /> Operator OSCoe Luckerman <br /> Addres P.0. Box 487 <br /> Telephone No. <br /> Legal Owner Zuckerman Mandeville, Inc New owner ye5 <br /> Address P.O. BOX 487 Telephone No. TD 469�7�0 <br /> No. Employees Housed 102 Occupancy Dates 1 1 97 From I?1 31 7 To Crop <br /> From To 5 Crop <br /> Total Number Days Used This Calendar Year <br /> Total Days Ocupied by 25 or more employees <br /> (Camps Occupied by 25 or more employeas for 60 or more days require <br /> a public water system permit-) <br /> rnaotive — IMPORTANT. If this camp is not to be used this year but is intended for use in the future, this application is to be <br /> returned marked "Inactive" too protect your land use status. <br /> FEE SCHEDULE <br /> 1 Permanent Camps Annual Permit $35.00 + No. Employees 102 a $12.00 each _ $ 1257.00 <br /> Orchard Camps $95.00 Transfer of Ownership $20.00 <br /> Amend Permit $20.00 + Additional Employees a $12.00 each = $ <br /> Late Application Penalty Fee $70.00 + ___ Employees ® $24.00 each = S <br /> Applicant agrees to all necessary inspections incident to issuance of permit ;o operate. <br /> Applicant agrees that this protect shall be operated and maintained in accordance with the Applicable provisions of the Employee <br /> Housing Act, Chapter 1, Part 1, Division 13 of the Health and Safety Code and Chapter 1, Subchapter 3, Title 25, CCR. <br /> Please remit in the enclosed self-addressed lope togeth r Ith ap lice. DO NOT SEND CASH. <br /> 11 /23/96 Coordinator <br /> Date Date Signed X Title <br /> ,�,. <br /> • Contact Environmental Health for i ormation and application for <br /> a public water system permit. UEG 1 01996 <br /> FOR DEPARTMENT USE ONLY <br /> Fees Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑January 1 d Received By Jan u lry.316Aeoe)ved By Jul`N <br /> BILLING REMITTANCE S <br /> REMIT <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUNT <br /> FEE lIl{ <br /> LESS <br /> PRORATION l <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by Date Receipt No. Permit No. tasuance Date MxlNwi Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES Post Office Box 388 Stockton, CA 95 201-0388 <br /> Office Address <br /> 304 E. Weber Avenue, Third Floor EH-0250(11188) <br /> Stockton, CA 95201 Phone (209) 462-3420 PHS179 (4�96) <br /> (No mail is received at this address) <br /> I <br />