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• , Si. JOAQUIN COUNTY • PUBLIC HEALT. ERVICES M '-ENVIRONMENTAL HEALTH DIVISION E- LEPV V tt 304 E WEBER AVENUE a THIRD FLOOR* STOCKTON, CA 9320 444�� 209/468-3420 JAN 2 8 1998 APPLICATION ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH PERMIT/SERVICES PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP D New Camp ❑Conditional Permit Annual Permit For Calendar Year ll 99 u Ameaded Permit u Multiple Years(Permanent Housing Camps on#) Wate Approved —change of Operator _ change of Owner i0ate Matted: —Change of Operator:Address _Change or Owner Address (Permit# 0000 —Additional Employees ICamt ID a 39-051 Please Note any Corrections or Changes In FacifiWOpendo►lOwuer 1xJbr w Won directly on this form ---—--------------------------------—...._.—._- --- - ----- - - - ---._—..---- ------------------------------ ---- f Site Name: LINDEN ORCHARDS 39-54 Location; 1100 E FRAZIER RD .� 3 ----------—.....-— - -— ---•--------•---•----•-------•------------------•----------------._...--- - - - --..._ - -----------------------------------------------......-.a Operator: JOSE GARCIA STOCKTON I ------ - ----- { ---—-------------—-— ---- --- Ma1Wtg Address: 1540 NEWPORT AVE, STOCKTON CA 95205 Facility Phone#: 209-931-3086 I Legal Owner: BOGGIANO,J&M ; ewj ew Owner UU Yes D N� •-----.------------------------------------------ Owner Address: 22261 E STOLTE RD,LINDEN CA 952--16 Owner Phone#: I -- - - - -— --- - -- — -- - ----— - -- -------------------------------------— —----- ----- ------— ----- --- — Community Facilities Provided by Camp: Community Kitchen: ❑ Yes ❑No Men: Number of Toilets Number of Showers Number of Lavatories _ Women: Number of Toilets Number of Showers Number of Lavatories Housing Accommodations to be Utilized this Year: Dulldhtas Employees Buildina to ees Dormitories: Owner Owned MR/RV SF Dwelltupfs Owner Owned RR Cares _ Apartments INULRV Spaces TOTAL of Both CoLuAvys Occupancy Dates: from (_/_to_(_/_ Crop Total Number of Days to be used this Calendar Year from—/ / to—/—/ Crop Total Days Occupied by 25 or more Employees I j —— NW: Camps occupied by 23 or owe emplo$ves jor 60 or more dater a year reyuc re a Public Mz&er Sjm1em Perm& ❑ Inactive pgn%w#: In order to protect vrwr land use status ifcame sWU not be uead this year but is intended fir use in tJhe flt1mr, Check this Box and re-hirn this appmea don. Fee Schedule � ❑ . Permanent Camp Annual Permit$33.00+Number or Employees: (a)$12.00 each=�+ � _ V u Orchard Camp Permit Fee=$95.00 $ ❑ Transfer of Ownership=$20.00 u Permit Amendment=$20.00+Number of Additional Employees A,$12.00 each=$ � ❑ Late Application Fee$70.00+Number of Employees r7u $24.00 each Fee must be.submitted with Application TOTAL FEE DUE: IS REhn'r TOTAL FEE AS CALCULATED.ABOVE IN THE ENCLOS I)self-addressed ENVELOPE. 11Af4RE CHECMPAE4BLET0: PHS/EHD I Applicant agrees to all necessary inspections Incident to Issuance or a PERM r To OPERATE. Applicant agrees that this project(camp)shall be operated and maintained In accordance with the applicable provisions of the EMMOYEE HOUM vo ACT,Chapter 1,Part 1,Division 13 of the mea&h and Safely Code and Chapter 1,Subchapter 3,Title 25.CaUfornia Code ofReguladons. Applicant Name(pleave print or type) Title _ Address _ Phone _ Applicant Signature _ — Date of Application _ Fes Amount Amount Paid Date of Payment I Pa ment Type 1 Cheok/Receiptil I Received ev I I I i EMD10Yee* 0843 1 Acct*0000031 Fec ID: 000031 1 PR* 270054 1 PWS IDft 1 PIE: 2755 1 - — — — -- 1---- -- — I 504886604886—�- -- ---------.�