Doh Form 4082 PDF Details

Doh Form 4082 is financial statement used to report the income, expenses, assets, and liabilities of a business. The form is typically used by small businesses and can be filed with the IRS. The form must be accompanied by a tax return, and it is important to understand how to complete the form in order to make sure that your business is compliant with tax laws. This blog post will provide an overview of Doh Form 4082 and explain how to complete it correctly.

QuestionAnswer
Form NameDoh Form 4082
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesMIGRANT, dormatories, Obsoletes, da form 4082

Form Preview Example

STATE OF FLORIDA

DEPARTMENT OF HEALTH

APPLICATION FOR A MIGRANT LABOR CAMP

OR RESIDENTIAL MIGRANT HOUSING PERMIT

 

 

 

Authority

 

 

 

Chapter 381.008-.00897

 

 

 

Chapter 64E-14, F.A.C.

Name of Operator: ______________________________________

______________________

_________

____________________

(Last)

(First)

 

(Telephone)

Street Address: _____________________________________________

__________________________________ ___________

____________

 

City

State

Zip

Mailing Address If Different: __________________________________

___________________________________

___________

____________

 

City

State

Zip

Doing Business As: __________________________________________

___________________________________

__________

____________

Company Name

City

State

Zip

Name of Facility:

_________________________________________________________________________________________________________________________________

Location of Facility: _______________________________________________________________

_______________________________________

 

County

Types of Housing Provided – Complete A, B or both based on the description of housing below

 

A.Migrant Labor Camp

Note: Migrant labor camps have communal gang type toilet and shower facilities or a central mess hall or both and may be occupied by singles or families, but the preferred use is for singles.

1.)

Number of dormatories

 

[

 

]

2.)

Number of barracks

 

[

 

]

3.)

Number of rooming houses

 

[

 

]

4.)

Number of other building structures

[

]

5.)

Proposed number of residents

 

 

 

 

 

 

to occupy all buildings

[

]

 

 

 

Facilities Provided (Migrant Labor Camps Only)

 

 

 

 

 

1.)

Number of communal toilets

 

[

 

]

2.)

Number of communal urinals

 

[

 

]

3.)

Number of communal showers

 

[

 

]

4.)

Number of communal hand washing sinks

[

 

]

5.)

Number of drinking fountains

 

[

 

]

6.)

Number of mess halls

 

[

]

 

 

 

 

 

 

 

B.Residential Migrant Housing

Note: Residential migrant housing has its own toilet, hand washing, shower, cooking and refrigeration facilities within the living unit.

1.) Number of single family living units including mobile home units:[

]

Duplexes

[ ] Triplexes [ ]

Quadriplexes [

]

 

Apartments[ ] Rooming Houses

[ ]

 

 

2.)

Total number of multi-family living units [

]

 

C.This Section Must be Completed for A or B Above

Type of Water Supply Provided:

Type of Sewage Disposal:

 

Municipal

[

]

Municipal

[

]

Private Well

[

]

Septic Tank

[

]

Other

[

]

Package Treatment

[

]

 

 

 

Other

[

]

I agree to operate and maintain the facility described above in compliance with Chapter 64E-14, Florida Administrative Code and any other applicable code.

________________________________________________

 

 

_____________________________________________________

 

 

Date of Application

 

 

 

Signature of Operator/Owner

 

 

 

 

 

 

 

 

See Instructions on back

 

Below for Completion by DOH Officials

 

 

 

 

Permit Summary:

 

 

 

Recommendation

 

Action

 

Date Application Received

___________

[

] Approval

 

[

]

Approved

 

Previous Permit Number

___________

 

 

 

 

 

 

 

Date Permit Issued

___________

[

] Disapproval

 

[

]

Disapproved

 

Class of Water System

____________

 

 

 

 

 

 

 

Water Supply Approval

____________

 

 

 

 

 

 

 

Authorized Capacity

____________

______________________________________

____________________________________

Sewage Disposal Approval

____________

Authorized Signature,

Date

Authorized Signature,

Date

Water System Upgrade

____________

______________________________________

____________________________________

New Audit Control No.

____________

 

Title

 

 

 

Title

 

DOH Form 4082,

June 98 (Obsoletes previous editions which may not be used)

 

 

 

 

 

(Stock Number:

5744-000-4082 – 3 )