Laserfiche WebLink
SAN -JOAQUIN COUNTY • PUBLIC IIEALTII SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION i <br /> 304 E WRBER AVENUE • THIRD FLOOR • STOCKTON CA 95202 • Phone: 2091468-3420 I <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE <br /> 9MPLOYEE HO.J:ING OR LAILOR CAflg� l <br /> ❑Now('amp 1.1 CendlUosal Permit 0-Annual Permit For Calestder Year <br /> ❑Amended Pervrtt Multiple Yews(Permanent Housing('quips mly) owed <br /> v Change of Operetor *Change of Owner owte Mailed. <br /> • Change of Operator Address • Change of 0ww Address enak N - <br /> • Additional Employees <br /> Please Note any CorreMions or(:ha es In FAC/sI .O eralor10",ner 1grwrinadon direct!y on this form <br /> Site Name: LIMA RANCH Location: 1343 N•I'HORNTON RD <br /> Operator. LIMA RANCH <br /> Malllul;Address: 13436 N THORNTON RD,LODI CA 95242 Facility Phone#: 209-3611-6442 <br /> Legal Owner: LIMA,JOHN P&HELEN TRUST ��Cy`ew Owow Cl Yes I N <br /> Owner Address: 13436 N'ITIORNTON RD,LODI CA 95242 Owner Phone#: 209-368-6442 <br /> Community Facilities Provided by Camp: Community Kitchen: i l Yps f/l�No I <br /> Men: Number of Tolleb ___ Nnmber of S1Mowers Number of Lavatories— <br /> Women: Nnmber of Tails"--_ Number of Showers_— Number of Lavatories__ <br /> Housing Accommodations to be Utilized this Year: <br /> #�4itdio� employees @ � Emmtaree+ I <br /> Dormlterles: Owner Owned M11/RV <br /> - Ow"or Owned RR Can <br /> SF Dwellings ---- <br /> Apartments - - - MH/RV Spaces <br /> -I'OTAr,of BothCOI.UMNS <br /> t:kcupancy I)atcs: <br /> Oro Total Number of Days to he used tds Calendar Year i P _ ___----- Total Days Occupied by 21 or mon Employees <br /> is_/_/_trop — - Neto: 02nyrs occupied by 11 or more em#vyees for 60 or otwe d w a war <br /> require a ParbNe WOW S rWem Penna! <br /> ❑ I wactive jai: In order toprotactyour land user status.if crimp wiJJ not be u+wd this year but is&de a,*dJ7r use in tk*JkAvv, Check this Bar.and rptu rn <br /> this gppNe Wan <br /> Fee SchedLde <br /> Permanent Camp Animal Permit$3500+Number of Employees _.--__S12.00 each--S ✓� Qy <br /> L) Orchard Camp Permit Fee=$95.00-S <br /> J;ranster om-vvnerhtp--S 0.00-S <br /> Permit Amendment=$20.00+Nnmher of Additions l lt'.mpl ype -_ �lYft>� $i each $ c� •L7 r� <br /> Application Fee 10.001 Nuwber of Lva to ties $24.00 each==$ <br /> ❑ Late AppU $ p > — � <br /> Fee must be.submitted with Application TOTAL FEL Dur.: <br /> Rimrr TOTAL FEE AS CALCULATFrI ABOVE IN THE NN MVIID self Addrevced ENVELOPE.. MOAN 01FC-.-Y PAYANLAfl7: PNS/F.HD <br /> Applicant agr"q to all necessary inspections incident to Issuance of A Plsatalrr To c)PFRATE. ApplIcant agrees that this project(camp)shay <br /> be operated and maintained in accordance with the applicable provisions of the rNm.oYEE nOUSrNo ACT,Chapter 1,Part 1,Division 13 of the I <br /> ,Headh and Safe(F Code and Cimpter 1,Subchapter 3,Title 25.C& fbrWa Code of Reguieflons. <br /> Applicant Name )11,4 f�� - --- Title40�_fi) /Cl' 1*astaaashlp D Cerpot"o" <br /> (Pfeam PF.W or TYPE) Addr;ss Ort 140i t JET_/�Ocf�� ,A Phone <br /> ApplicantSignature y/ to of Application <br /> Program Record IDN 20"% 3;cnity IDK 003419 — -- Acconnt HW 0002995 <br /> - %vriZ Paw Deas oT—Pavan raiment TypeT- cr it Receipt It _itecet_vedBy <br /> Empl a#►- J1tct N i Fec �` —PR <br />