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yW4 o <br /> Applications Will Be Processed When Submitted Properly Completed. Be pure To Sign The Application. <br /> OFFICE USE ONLY <br /> For Calendar Year 1 9q6 Area <br /> Multiple Years (Permanent Housing Camps) <br /> Conditional Permit <br /> Date Approved <br /> I.D. No. APPLICATION Permit <br /> (For Non-Transferable, Revocable, Suspendable) Date Mailed <br /> ENVIRONMENTAL HEALTH PERMIT New Existing <br /> Faz- 0 0-a 9q_;i_ TO OPERATE <br /> Change <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> FEE IS DUE WITH APPLICATION <br /> Location Mandeville Island Stockton, California 95219 <br /> Operator CCRC Farms <br /> Address P.O. Box 248 Holt, Ca 95234 Telephone No. 209 464 2959 <br /> Legal Owner CCRC Farms New Owner Yes XX No <br /> Address P.O. Box 248 Holt CA 95234 Telephone No. <br /> No. Employees Housed Occupancy Dates From March 1 To Ma 1 <br /> Y CropAs paracTus <br /> From January 1 To December 31 CroIS" <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 /> Permanent Camps Annual Permit $35.00 + No. Employees 50 0 $12.00 each = $ 635.00 <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 /> O'AYMENT <br /> pFF,r r,irr-r% <br /> Applicant agrees to all necessary inspections incident to issuance of permit to operate. 1�ll E'C ff�� <br /> Applicant agrees that this project shall be operated and maintained in accordance with the Applicable provisions of the�irtplGye1 3 1995 <br /> Housing Act, Chapter 1, Part 1, Division 13 of the Health and Safety Code and Chapter 1, Subchapter 3, Tip 25, CCR. COUNTY <br /> Please remit in the enclosed self-addressed env o e together with applicable fee. DO NOT SEND C PUBLi(, L I H SERVICES <br /> -"RONMENTAl._HEALTH 0!i /ISIQN <br /> Date 11-27-95 Signed X Title G—en va"at t rL\ <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 $ 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 <br /> rmit No. Issuance Date Mailed Delivered <br /> NEW OFFICE & MAILLING ADDRESS IPERMIT/SERVICES P 0 Box 2009 STOCKTON,CA 95201 <br /> 304 EAST WEBER AVENUE , STOCKTON CA EH-0250(11/88) <br /> (Nu Mail Received At. This Address) <br /> P . O . BOX 388 , STC)CKTON CA 95201 <br />