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S JOAQUIN COUNTY . PUBLIC HEAL] ERVICES a�A 0q+q 3t ENVIRONMENTAL HEALTH Div .�.iION m 304 E WEBER AVENUE s THIRD FLUOR. STOCKTON, CA 95202 P,,AYNKEN 1' 209i468-3420 APPLICATION ENVIRONMENTAL HEALTH DEC 2 9 1997 PERMIT TO OPERATE CEMPLOYEE HOUSING OR LABOR CAMP �� OLIN i CIJNIY r ^,.LIC.PALM SFIIVICES New Camp v Conditional Permit u Auurli�� riION'1 L,Amended Permit a Multiple Yeats tTermanent Housing Camps ou(F) Pate Approved j —Change of Operator _c=hange of l]wner ,Date Mailed: —Change of Operator Address — Chanue of Owner Address d'etmit a X004 Additional Employees LCamp ID;i 39 1 Please Note any Corrections or Changesin FaclAWOperWor Onvter Itt fbmiallan directly onthis form - - - ----------------------- -- - = — - - -- — --- -- ---------------— - —--------- -- - O ------- Stte Name: LUNA LABOR CAMP 39-120 Location: 13631 N HURD RD ----------------•--— - — -- ------------------------------— Operator: YAMAUCHI.YOSHM LODI Mallin-Address: 1500 VISTA DR.LODI CA 95242 Facility Phone#• 209-368-2403 Legal Owner: YAMAUCHI,YOSHIYE ,New Owner ❑Yes ❑Noi ! Owner Address: 1500 VISTADR,LODI CA 95242 Owner Phone#: 209-368-2403 Community Facilides Provided by Camp: Community Kitchen: it Yes M No Men: Number of Toilets -' Number of Showers Number of Lavatories -- Women: Number of Toilets Number of Showers Number of Lavatories — 1lousin2 Accommodations to be Utilized this Year: Buildivas Employees Buildings Employees Dormitories: Owner Owned MRIRV SF Dwellings Owner Owned RR Cars Apartmenu M&RV Spaces TOTAL of Both COLUMNS Occu aue Dates: from—/ , / �� / /O►Q crop �. t Total Number of Days to be used this Calendar 1"ew, �% ��' Lia Total Days Occupied by.S or more Employees L _� from /_/ to /_�Crop LA Nom: uvnps occi4pied by 15 or mare empioycesjur 60 or more dgpsa year require a Public Wafer Syaem Penn" ❑ Inactive Important: In order to protect your land use status,ifcamp will not be used this Year but Islntendedfor use in the fliturc. Cheek this Boz and return this appllr�dlon. ee Schedule CiI V V ❑ Permanent Camp Annual Permit$35.00+Number of Employees r7$12.00 each=$ Orchard Camp Pernilt Fee=$95.00 $ y ❑ Transfer ofOwnership=$20.00 $ i Permit Amendment=$20.00+Number of Additional Employees Cis 4x12.00 each= ❑ Late Application Fee$70.00� Number of Employers _ (a`$24.00 each Fee must be submitted with Application TOTAL FEE DUE: I$ ! RvNnT TOTAL FEE AS CALCULATED ABOVE LN THE ENCLOSED self-addressed ENVELOPE. A14kT CHEChSPAY.4BLE TO: PHS/EH Applicant agrees to all necessary inspections incident to issuance of a PERMrr To OPERATE. Applicant agrees that this project(camp)shall be operated and maintained in accordance with(.ire applicable provisions of the.EMMOYF.F HousiNo ACT,Chapter 1,Part i,Division r3 of the Flealik and i'Va etp Code and Chapter 1,Subchapter 3,Title 25,Californian Code efRegaladow. Applicant.Name(phase print or type) �C)C'mX-4 �l�N k)CA_t I 'Title ) —i- - Address k) )� Phoned Applicant Signature s l ._. Date of Application Amount Amount Paid Date of Payment Payment Type Check/Reeei til i Received B 3 Acct*0000453 Fat ID: 000454 PR#: 270120 PWS IDS: PIE: 2755/,,��c, -- V/ONL