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Applications WIII Be Pro�..issed When Submitted Properly Completed. Be b.,re To Sign The Application. <br /> OFFICE USE ONLY <br /> For Calendar Year 1996 Area <br /> Multiple Years(Permanent Housing Camps) <br /> _ Condition I erryjt_I <br /> Date Approved <br /> I.D. No. �� LP APPLICATION Permit <br /> (For Non-Transferable, Revocable, Suspendable) Date Mailed <br /> ENVIRONMENTAL HEALTH PERMIT New Existing <br /> TO OPERATE <br /> Change <br /> EMPLOYEE HOUSING OR LABOR CAMP T�ty SfC„1,r�t <br /> luo- Day c103 FEE IS DUE WITH APPLICATION l <br /> lhq,rIc 54cf,4 C►h) qyZ- <br /> Location Cn 21 ; Henning Tract, McDonald Island <br /> Operator Rocco Zuckerman <br /> Address P_O Rox 487 Telephone No. 209 469 7979 <br /> Legal Owner Z.uckermna-""=-:�rq v!IIe Inc. <br /> 9 New Owner Yes No <br /> Address P.O. Box 487 Stockton, CA 95201 Telephone No. 209 469 7979 <br /> No. Employees Housed 102 Occupancy Dates From 1 /1 /96 To 12/31 /96 Crop <br /> From To Crop <br /> Total Number Days Used This Calendar Year 365 <br /> Inactive— 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 ® $12.00 each = $ 1259.00 <br /> Orchard Camps$95.00 Transfer of Ownership$20.00 <br /> Amend Permit $20.00 + Additional Employees ® $12.00 each = $ <br /> Late Application Penalty Fee $70.00 + Employees @ $24.00 each = $ <br /> {{ I r <br /> Applicant agrees to all necessary inspections incident to issuance of permit to operate. <br /> Applicant agrees that this project 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 velop to ther with applicable . DO NOT SEND CASH. <br /> Date 12/29/95 SignedX - Title Coordinator <br /> • <br /> FOR DEPARTMENT USE ONLY <br /> Fees Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1&Received By January 31 ❑July 1 &Received By July 31 <br /> BILLING REMITTANCE y REMIT <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUNT <br /> FEE <br />' LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER I I n <br /> C/JL/ <br /> �. Issuance Date Mailed Delivered <br /> NEW OFFICE & MAILLING ADDRESS MIT/SERVICES P 0 Box 2009 STOCKTON,CA 95201 <br /> 304 EAST WEBER AVENUE, STOCKTON CA ,e`' EH-0250(11/88) <br /> (No Mail Received At This Address) <br /> P . O. BOX 388 , STOCKTON CA 95201 <br />