Laserfiche WebLink
oaquin County-Environmental Health Depar <br /> 304 E Weber ,nue-Third Floor-Stockton CA 95202-Phot,. 09-468-3420 <br /> i JI- <br /> APPLICATION { )r <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP I I• <br /> ❑New Camp ❑ Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) ]Annual Permit for Calendar Year , <br /> ❑Amended Permit: *Change of Operator *Change of Owner r� <br /> *Change of Operator Address *Change of Owner Address <br /> *Additional Employees <br /> Permit ID#: 0007247 <br /> Please Note an.y Corrections or Changes in Facilih,/Operator lnforntalion directly on this I Camp ID#: <br /> Site Name: CATON, DARRYL J Location: 15635 S STEINEGUL RD,ESCALON <br /> Operator: CATON,DARRYL J <br /> Mailing Address: 15206 S STEINGUL RD,ESCALON CA 95320 Facility Phone#:(209)838-3181 <br /> Legal Owner: CATON, DARRYL J New Owner? ❑Yes ❑No <br /> Owner Address: 15206 S STEINGUL RD, ESCALON CA 95320 Owner Phone#:(209)838-3181 <br /> Community Facilities Provided by Camp: Community Kitchen: LJ Yes NLJ <br /> ,NIcu: NumhciufToiica _ Nmuberol'Shu.vars Nwub:,rofLacatores <br /> Women: Number of'1'oilels Number of Showers Number of Lavatories <br /> Housing Accommodations to be Utilized this Year: Occupancy Dates: <br /> Buildings Employees from_/_/ to_/ /_Crop _ <br /> Dormitories from_/_/_to_/_/_Crop _ <br /> SF Dwellings <br /> Apartments Total Number of Days to be used this Calendar Year_ <br /> Owner Owned MH/RV Total Days Occupied by 25 or more Employees_ <br /> Owner Owned RR Cars Note: <br /> MH/RV Spaces Camps occupied by 25 or more employees for 60 or more days in a year <br /> TOTALS require a Public Water System Permit. <br /> ❑ Inactive <br /> Important: In order to protect your land use status,if camp will not be used this year but is intended for use in the future,Check this Box and return this application. <br /> Fee Schedule &C <br /> ❑Permanent Camp Annual Permit Fee: $35.00+ Number of Employees @ $12.00 each=S��D. <br /> ❑ Orchard Camp Permit Fee: $95.00=S <br /> ((��'77 Transfer of Ownership: $20.00=$ <br /> ❑ Permit Amendment Fee: $20.00+ Number of AA'Rtlional Employees @ $12.00 each=$_ <br /> Late Application Fee: $70.00+ Number of Employees @$24.00 each=$ <br /> Fee must be Zii milted with Application <br /> TOTAL FEE DUE: <br /> Remi TOTAL FEE as C MLCULAT D ABOVE iu;;ie ENCLOSED Self-Addressed 7iivelolre <br /> MAKE CHECKS PAYABLE TO: PHS-EHD v! �- <br /> Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project(camp)shall he operated <br /> and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT,Chapter 1,Part 1,Division 13 of the California Health <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulations. <br /> Applicant Name as r st VL Title p U)17 L y— ❑ Partnership <br /> (Please PRINT or TYPE) , ❑Corporation <br /> Address 3pZ() Phone- _;) /fz <br /> Applicant Signature 1 Date of Application /,;z <br /> Amount Paid Date of Payment Payment Type E lf2ecelpt# Received By Account ID <br /> C• PC0003037 <br /> '' <br /> ur .D c� <br /> Facility ID Program Record ID PIE Assigned to PWS ID <br /> 0003460 0200071 / 2"' S. a 77 9374-GODINHO 0007247 <br /> Report#:7066.rpt ,l�Nl/ t/� Q � Application Printed:11120/2002 <br />