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EHD Program Facility Records by Street Name
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MARCH
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2700 - Employee Housing Program
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PR0545930
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Entry Properties
Last modified
12/14/2022 3:55:34 PM
Creation date
10/6/2022 9:09:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2700 - Employee Housing Program
File Section
BILLING
RECORD_ID
PR0545930
PE
2755
FACILITY_ID
FA0025973
FACILITY_NAME
MOTEL 6
STREET_NUMBER
2654
Direction
W
STREET_NAME
MARCH
STREET_TYPE
LN
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
2654 W MARCH LN
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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PAYMENT <br /> RECEIVED <br /> San Joaquin County-Environmental Health Department <br /> 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209-468-3420 JAN <br /> 11 <br /> 2021 <br /> SAN JOAQUIN COUNTY <br /> APPLICATION ENVIRONMENTAL <br /> ENVIRONMENTAL HEALTH HEALTH DEPARTMENT <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) Annual Permit for Calendar Year 'Z CJ 2 I <br /> ❑Amended Permit: "Change of Operator "Change of Owner <br /> 'Change of Operator Address "Change of Owner Address Permit ID#: 0027506 <br /> "Additional Employees <br /> State ID#: <br /> EH ID#: <br /> Please Note any Corrections or Changes in Facility/Operator Information directly on this form. <br /> Site Name: MOTEL 6 Location: 2654 W MARCH LN,STOCKTON <br /> Operator: BARRERA,LUIS <br /> Mailing Address: 17450 AVEN IDA LOS ALTOS,SALINAS CA 93907 Facility Phone#:(831)229-0682 <br /> Legal Owner: RANCHHODRAI INC New Owner? ❑Yes ❑ No <br /> Owner Address: 4219 E WATERLOO RD,STOCKTON CA 95215 Owner Phone#:(831)229-0682Ext:LUIS <br /> Community Facilities Provided by Camp: Community Kitchen? ❑ Yes [El-No <br /> Men: Number of Toilets 5 Number of Showers r�j Number of Lavatories 50 <br /> Women: Number of Toilets Number of Showers Number of Lavatories <br /> Housing Accommodations to be Utilized this Year: Occupancy Dates: <br /> Buildings Employees tf ' QP <br /> Dormitories 5o 2-2-00Ofrom r / Tt/ Zr to/Z l fl l 21 Crop Lke-/V t,e f ,04,U <br /> SF Dwellings from / / to_/ / Crop <br /> Apartments <br /> Owner Owned MH/RV Total Number of Days to be used this Calendar Year: _20 <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: 20 <br /> MH/RV Spaces Note <br /> TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year <br /> 20 V Require a PUBLIC WATER SYSTEM Permit <br /> ❑Inactive <br /> 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. <br /> Fee Schedule <br /> Permanent Camp Annual Permit Fee $50.00+ Number of Employees Zay @$15.00 each=$ U <br /> ❑ Transfer of Ownership $25.00=$ <br /> ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$15.00 each=$ <br /> ❑ Late Application Fee $100.00+ Number of Employees @$30.00 each=$ <br /> Fee must be submitted with Application 3,O 5O <br /> TOTAL FEE DUE$ <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed Envelope <br /> MAKE CHECKS PAYABLE to EHD <br /> Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project (camp) shall be operated <br /> and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT, Chapter 1, Part 1, Division 13 of the California Health <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulations. <br /> Applicant Name Lj/1 S QALY c,%, Title LA tUV U t t/ ❑Partnership <br /> (Please PRINT or TYPE) d El corporation <br /> Address 1}y50 ' S s to CA Sao-+ Phone V51— 01)7— 15`�a <br /> Applicant Signature Date of Application / -17-1 <br /> Amount Paid Date of rayment Payment Type Check/Receipt# Received By Account ID <br /> O ; ' I 0049218 <br /> Facility ID Program Record ID PIE W` 1 Assigned to PWS ID <br /> FA0025973 PR0545930 2755 8987-SANGALANG N/A <br /> Report#:7066 Application Printed:11/19/2020 <br />
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