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Applications J 111 tie P►oeeeNd W PP 1• When Submitted Properly Completed. 6e Sure To Sign The Appifeatlon, <br /> OFFICE USE ONLY <br /> For Calendar Year <br /> Area <br /> Muttiple Ysere(Permanent sing Camps) APPLICATION <br /> �qq Conditional Permit Date Approved <br /> -SLL�I.D. No. (For Non-Transferable, Revocebia, Suapendabls) <br /> Permit <br /> ENVIRONMENTAL HEALTH PERMIT <br /> DD`�l l 3 Dais Mailed <br /> TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP New—Existing <br /> FEE IS DUE Wt1N APPLICATION Change <br /> Location 14000 E. 8 Mile Road, Linden Ca 95236 <br /> operator A. Sa4baLo & S n Inc. <br /> Address 8077 N_ Tully Telephone No. 202-931-2568 <br /> Legal Owner ^— <br /> Addrow same New Owner Yea _�No <br /> Telephone No. <br /> No. Employees Housed 8 - 10 Occupancy Dates From Auril To November Crop Orc err s w <br /> Fran To Crop <br /> Family Housing Total Number Days Used This Celendw Year <br /> Total Days oeupied by 23 or were espleyaes None . • <br /> (Casper OeaWisd by 23 or sore eployea■ for e0 or sera days requlr <br /> Pubita water syetas persit•) <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 statue. <br /> PEE SCHIPULE <br /> Permanent Catrtpa Amwel Permit 935.00 • No. Emp"S 10 0 $12.00 each a = 155•00 <br /> Orchard Conine r$Yd.00 TrsrMer of OMMMip$29.00 --- <br /> Amend Per"It 320.00 a Additional Employees 0 812.00 each s,_, <br /> Late Applles"n Penalty Fee$70.00 • Pmployeee M $24.00 sash a I <br /> APp00ant sprsss 10 00"COOS"Inapeattons Ineldenl to issuance of permit to operate, <br /> APpBearR a0rses tftat txolef t OW be opmated ant!n*nlained in accordance with tits Appreabio povlelo-o et tots ev" <br /> Housing Act, Chapter 1 Part 1.Division 13 of the Hearth and 9a"gods and Chapter 1, Subohapter 3.TK*2S, OCR. <br /> Please remit In the ertdoad 000-60 envelope together with Ie lee. DO NOT SEW CASH. 'iv!Ak 17 IJJ/ <br /> Date 3 Z sgn.d AN JOAOU►N_riol,n,r� <br /> ��7H.SERVICES• contact 88tvlro"tal heal let lrttersation and aPPlivatloR toe CNVIROIyMErjrhl.HEALTH DIVISION <br /> Publia vator aystias perult. <br /> FOR DEPARTMENT USE ONLY <br /> Fees to Due; O AM MANY D!PER uuaT O Den one 17 ua O jwwm+a Raewa ay 31 O +.a..r..e <br /> seam <br /> SAN QMA"TION _� Aa omit AMC( AMOUW WA <br /> FEE ww00�lUJMMTT <br /> LESS <br /> T <br /> PLUS <br /> OTNCn <br /> OTHER <br /> iz . of ow. Ipubow NO. Me. where.Ow waido <br /> A►micAu►"mrrum Au eOrtsa To: VAP010010I011MTAL M11A1110 PatttarTf9V wosa Post Office Box 388 Etocktotl, a 95201-0388 <br /> Office Address <br /> 304 E. Weber Avenue, Thllyd floor 1111"�tlrmsl <br /> Stockton, CA 95201 Phone (209) 468-3420 pHs 179i4t%1 <br /> (No malt to received at this address) <br /> T d ^o I :60 L6/COi EO ljoa j <br />