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SAh' -'sIAQUIN COUNTY • PUBLIC HEALTH SERV- S VVIRONMENTAL HEALTH DIVISION 304 E WEBER AVENUE • THIRD FLOOR • STOCKTON CA 95202 • Phone: 209/468-3420 APPLICATION ENVIRONMENTAL HEALTH PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP New Camp Conditional Permit Annual Permit For Calendar Year Amended Permit Multiple Years(Permanent Housing Camps only) jDate Approved • Change of Operator *Change of Owner 113ate Mailed: • Change of Operator Address • Change of Owner Address JPernnt • Additional Employees JCamp Please Note any Corrections or Changes in Facility/Operator/Owner Information directly on this form. Site Name: LINDEN ORCHARDS 39-54 Location: 2110 E FRAZIER RD Operator: JAVIER GARCIA --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Mailing Address: 3431 CARPENTER RD, STOCKTON CA 95215 Facility Phone#: 209-931-3086 ---------- --------- ----------------------------------------------------------------------------------- Legal Owner: BOGGIANO,J&M --- ew Owner Yes No Owner Address: 22261 E STOLTE RD,LINDEN CA 95236 Owner Phone#: Community Facilities Provided by Camp: Community Kitchen: Yes No Men: Number of Toilets y Number of Showers Number of Lavatories_f Women: Number of Toilets Number of Showers Number of Lavatories Housing Accommodations to be Utilized this Year: Buil m s Employees Build' s Emplptees Owner Owned MH/RV Dormitories: SF Do Dwellings Owner Owned RR Cars Apartments MH/RV Spaces TOTAL of Both COLUMNS Occupancy Dates: J� from / /0 to Crop `j Total Number Days used this Calendar Year Total Days Occupied byy 255 or more Employees lao to from '7 $ /p�Crop Lf Note: Camps occupied by 25 or more employees for 60 or more days a year require a Public Water System Permit. Inactive 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. Fee Schedule 2 i,,/ Permanent Camp Annual Permit$35.00+Number of Employees J $12.00 each=$ 0 J pfea ' LL Orchard Camp Permit Fee=$95.00=$ )L3-Ob Transfer of Ownership=$20.00=$ Permit Amendment=$20.00+Number of Additional Employees @$12.00 each=$ Late Application Fee$70.00+Number of Employees @$24.00 each=$ Fee must be submitted with Application TOTAL FEE DUE: REMIT TOTAL FEE AS CALCULATED ABOVE IN THE ENCLOSED self-addressed ENVELOPE. MAKE CHECKS PAYABLE TO: PHS/EHD Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project(camp)shall be operated and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT,Chapter 1,Part 1,Division 13 of the Health and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulations. ftp, PP 1 n�n C�rc�►�►rd j gal Ga�� `n rs 9-eo 7 Applicant Name �, tl 1•d�� Title r Partnership Corporation (Please PRINT orTYPI;) Add ss all oa A. t%a-r' /7dr Phone Applicant Signature Date of Application Program Record 270054 Facility ID# 000031 Account ID# 0000031 Amount Paid Date of Payment Pa ment T e Chec Recel t# Received B O 0 1. -00 Employee#: Acct#: Fac ID: PR#: P S I D#: P/E: