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i <br /> Applications WIII Be PrWd When Submitted Properly Completed. Be Sur cation. <br /> OFFICE USE ONLY 5 <br /> For Calendar Year 1,%,5 <br /> Multiple Years (Permanent Housing Camps) APPLICATION <br /> Conditional Permit Approved <br /> I.D. No. 7 (For Non-Transferable, Revocable, Suspendable) it <br /> ENVIRONMENTAL HEALTH PERMIT <br /> Mailed <br /> TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP Existing <br /> FEE IS DUE WITH APPLICATION ge <br /> Location 5125 S . Kaiser Rd . Stockton Ca . 9,D215 <br /> Operator Rose C . Atad <br /> Address 5125 S . Kaiser Rd . o c c o n, a . 5 � Telephone N — <br /> Legal Owner Martin And Rose .A a New Owner —No <br /> Address �125 S . Kaiser Rd . Stockton, Ca . 95215 _ Telephone <br /> No. Employees Housed 25 Occupancy Dates From To Crop 0:-1/1 jU,) <br /> From To .Crop <br /> Total Number Days Used This C� <br /> Total Days Ocupied by 25 o + <br /> (Camps Occupied by 25 or mot 60 or more days require <br /> a public water system psma <br /> Inactive — IMPORTANT. If this camp is not to be used this year but is intended for us( this application is to be <br /> returned marked "Inactive" too protect your land use status. <br /> FEE SCHEDULE <br /> _% Permanent Camps Annual Permit $35.00 + No. Employees 25 ® $12. 5 .00 <br /> Orchard Camps $95.00 Transfer of Ownership $20.00 <br /> Amend Permit $20.00 + Additional Employees (a $12. <br /> Late Application Penalty Fee $70.00 + _ Employees ® $24. <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 Appli ie Employee <br /> Housing Act, Chapter 1, Part 1, Division 13 of the Health and Safety Code and Chapter 1 le 25, CCR. <br /> Please remit in the enclosed self-addressed 4gvelope together with applic ble . DO N <br /> i j <br /> Date Jan . 3�— Signed X =% r Title r <br /> • Contact Environmental Health for information and application for RECEIV <br /> a public water system permit. �stla ig <br /> F E B 3 1995 <br /> .) o 1 Y <br /> FOR DEPARTMENT USE ONLY PUBLIC HFAL.TH r,ERVI .FS <br /> Fees Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ElJanuary 1 3 Received 'j 'tt�i}'`I*6 4�d by my 91 "r: E, ,i` 'i" <br /> BILLING REMITTANCE S REMIT <br /> BASE EXPLANATION DATE DATE REMITT UE CHECKED <br /> AMOUNT <br /> FEE <br /> LESS <br /> PRORATION _ <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> vid <br /> cReceived by Date Receipt No. Permit No. Issuance Date - DOW.Wed <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES P.O. tockton, Ca. 952 01 <br /> OFFICE ADDRESS EH-0250 (11/94 ) <br /> tO45 N.SANRECEIVE JOAQUIN ST.,STSADDR,CA phone (209 ) 468-3420 <br /> (NO MAIL IS RECEIVED AT THIS ADDRESS) <br /> 1 <br />