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r • � G,H. <br /> .._.,JOAQUIN COCrIjgTy a pUBLrc HEALTH �_ <br /> itNv2Ro2♦* E'XTAL HEALTH IfIVi9 ON ES 'l <br /> 304 F WEBER AVENUE e T • / ``,-�/ <br /> }CfRi] i''LaOR + STOCKTO CA 95202 • Phone: 209/468-3420 .' <br /> A;PNf LJOATiO ; <br /> EN1/tFt NMENTAL HEALTH �' 4 �' ' ! F <br /> f p PERMIT TO OPERATr_ { <br /> D tYew camp e O 'ARE4 <br /> 13 --�Conditiould Permft <br /> Amended Permit ®Annual Permit Par Cfstopdar Year <br /> • Clsungb of es dor + 8 muitiple Yema(Permanent Ilendag arch) S <br /> Ctsan e.ofvurr Camps ute roved <br /> ' C"ls ge off rsstarr}.ddress • ounge ofChvner Address t <br /> • Additfoual Employees �, ute Aial)ed: <br /> enasll# 40251 � <br /> j 'Flea.Note anv Carrre*nvnr t_Wrnpow to Far 119p 0FA)W1wInjorrrralYon direclfi�•on flits farm am ID rr 3 042E.S t <br /> i �5ite Name:. -= t k <br /> S.ARAI,E-FARMS INC 9-its MI S/CLIFTON Bc.GALPACK R CT <br /> C-,,*Ater: SARAI.E FARMS INC --`— <br /> 1Vlst11109 Address: PO BOX 6066, STOCKTON 95-106 <br /> ---- <br /> L()Z:r <br /> CA AR ttl.E i"ARMS Owuer: S I'aci]it�Phone#• �09-943-2FT�C079 <br /> Address: i 650 _IFTON CT STlit kTON <br /> CA 95206 <br /> Cu utu t FacJtl e o ed b a Owner Phone#: 209-943-20 7-9 <br /> Men: Number of Toitots •JCommunty Kkx"A: re„ ©No <br /> Woman: Number Number ofshow7 <br /> FAUCETS <br /> lu L <br /> Number of <br /> Number of shsswati L•aterler — t <br /> Hauslu AccomIDOdations to be UtWzed this I•ear., —�- Number ofL vvarlee -_ <br /> Aermitnrless: t <br /> sF weninop �Cf j Owner Owned rvMfRv LUM4410 ° eS <br /> Aparbeeno Owner Owned RR Can ---�--- <br /> +1+&Rv spades; -�—_ <br /> - a I�afes:--�.�,�_ _ Tar tL of nosh COLUAMpAsp <br /> TotalivumborefDaye to be th6 C'sttenslgr Year <br /> from— to�1 / p -raw 14tys <br /> Occupied by 25 or mom F'mplayees <br /> �%ar>gns rx cs yx�d 6y,IS ar swo c saslseu;/or riffNroy�q o <br /> Inacth a Ian. ri+►rx In order to �' re P"kc Hsi&P 4r ucm pry <br /> this rrppllesa Protect your land use statux t fca»?r�Wtt not be u4nd this year blo fr farefid d ti <br /> s7sa(a l*,e j mft CW-k this Box and return 1 <br /> &ee Se <br /> hedule <br /> �! Permanent rump Arlrlual Permtt$3.,c <br /> .041+Number of Employees __ q y <br /> --------.-._....$12.0(!{^.srch <br /> E.3. Orchard Camp Vern it Fee 1+95,00�S <br /> n x_ <br /> Fer -Transfer,ef0wnershl $ J <br /> etttt Amendment—$20.00 i-i�iure4er of Additlonsa!Ifpsployeesr P 20.00 S=, <br /> n f <br /> © Late Application Fee S 70.00+Namber of Empl _ �oyees $12:( ouch <br /> ----�-.�..� @-524.00 each=S - <br /> Fere mast he submitted with Application <br /> torr TOTAL Fags As CALCULAT90 AHa TOTAL FEr,Dom: <br /> 51 <br /> V$IN 13iii SNCLCA�Bb self:addressed$ g�,gP1S, AfdAv CNECXNPAY,fBL67Yl. l+I l/b;� <br /> Applicant agrees to s31t ris'txssary iris A <br /> het► are <br /> perated anti maintained to accordancenwlth heapPgCable provisioon titfhe E oyg HOTTMG qty <br /> Nealrflt 4nd Sdfet>Cotteand C7tapter 1,Subcha <br /> ter <br /> 3 that this Ira est(camp)shall <br /> p ,Title 2S,Calf%rnfu Cods 0 R T-Chnntnr 1.Parc 1,Division Y$orthe <br /> Applicant Name H S t l egulartofas. <br /> (Ftease PRINT or 77PE) s <br /> Tltle �� { <br /> Addt 0 pspftsshlH �I�Cerporssctap � <br /> Applicant Signatures <br /> r"F*w record W# 270"5 nate of Applkatlon f <br /> Fuclllty;D# tW2}idl - - _ <br /> Aceoant gfi02,623 <br /> os mount Amount Paid <br /> Er los#P� 6,/S.G'C-� 43)te at nt !'a rtt has Rene t <br /> Y Res:eivad <br /> --•.,—_�.�_ _ Asci# act ` c t <br /> PR sf �{�, f <br /> �J W6. 1•)E: <br />