Laserfiche WebLink
No. 0092 <br /> 4g1�� <br /> San.ioac)pin County-)environmental Health Department Please send Check to <br /> 600E,Main Street-Stockton CA 95202-Phone: 209-463-3420 C.C.R.C. Farms LLC <br /> APPLICATION Thank you, <br /> FNVIRONMENTAL tICALTR <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP I <br /> ❑New Camp ❑Conditional Permit © Multiple fears(Permanent tiouting Cpmps only) ix Annual Permit for CRlendar Year D C `-7 <br /> ❑Amended Permit: Change of Operator 'Change of Owner <br /> 'Cbengeof Operator Mdrrav 4Changeor Owner Address <br /> "Addihonp)Employe(* <br /> Permit LD#: 00o ;4CI <br /> Please.Xote arry Corrections or Changes in l"acillly%Operator Information direelly on fhi_; Camp ID#: <br /> Site Name; C,C•2.C_. � t/W1 LLC - 9(0 C) Locution:ab�Sp L13.jk4oe1 Le V e /ed <br /> Operator:C-,c.V—, C. V7q,✓ LLC, <br /> Mailing Address, I -1 Facility Phone !: __d\r1S9 <br /> Legal Owner; 0-0 2 C` Y L1� hew(Twner? ❑Yes ❑ No <br /> Owner Address: P O Sox a 1_- o t+ CA Clsa3 On'ncr Phone 9 (B H-a CI <br /> Community facilities ProridA byS_.amn: Community Kitchen? ❑ Yee ❑ No <br /> iMen: Nurnt=of Toilets �j Number of Shower• 3 Number of Lavatories <br /> Women: NurnberofToilct3 NumberofShowen NumberofLavaiorin <br /> H uslngrAccommodations to be Litilucd this Year. OccEpancvDatcs: <br /> Buildines Emolovees <br /> Dormitories _ from t�I P 1 I a U loco l�-/ 3 119 U 17 c,p <br /> SP Dvrllings from _/_/ to_ ! Crop <br /> Apartments " <br /> O%vner Ov,ned MH/RV `total Number of Days to be used this Calendar Year; (o <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: <br /> MFl/RV Spaces <br /> ]Vote. <br /> TOTALS ( Cheops occupied by 25 or more Employees for 60 or more days in it year <br /> u C� Requirr A PUBLIC WATER SYSi'ENI Permit <br /> ❑Inactive <br /> important: Lt ordtr to proteer your land use sratus,if camp will not be u ed this year but is iiileadtd for use in rho future.Check this Bav and retutr this application. <br /> 45.co FceSchedule rS.00 o S oa <br /> Permanent Camp Annual Permit Fee S35 t Number cf Employee; C _ , 0 e,.ch=S <br /> ❑ Orchard Camp Permit Pee $95.00-S <br /> ❑ T=fer of ownership $20.00=$ <br /> ❑ Permanent Amendment Fee $20,00+ Number of Additional Employees CO)S 12,00 each=S <br /> ❑ Late Application fee $70.00+ Number of Employees @ SZ4.00 each=S <br /> Fee must be submitted with Application <br /> TOTAL F1rE Di,'E$ '� la-O. UU <br /> RemitTOTAL IrEE os CALCULAT)l)ABOVE in the ENCLOSED Self Adressed Envelope <br /> MAkE CffLCKS PAYABLE to EHD <br /> Applicant agrees to all necessary inspections Incident to limance of a PERMIT TO OPERATE. Applicant agrees that this project(camp)ahali be operated <br /> and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING;ACT,Chapter 1,Part 1,DhIsion 13 of the Calrjornla Health and <br /> Safely Code flnd Chapter 1,Subchapter 3,T itie 25,CaUfornia Corp ofRegukltlons. <br /> Applic.Ut Name t✓[G�0 WQkr 'l0.k�_P_ Title MCI VIGJR.f ❑Pathersnip <br /> pess9PRIffr ypt_. ❑Corpomtion <br /> Address TO 'Box a q SZ3q Phone �91)4(44- 9 5� <br /> Applicant Signature Date of Application 1-7 <br /> Amount Paid Date of Payment Paymoot Type Cheeafltecelpt# Received By Account ID <br /> Facility ID Program RALOM ID PIE Assigned to PWS ID <br /> ,2`l�jZ t�/t1�2701� ; 6oS <br /> Report#:7007.rpt Applim tan Printed:6/9/2000 <br />