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San Joaquin County-Environmental Health Department <br /> 1868 E Hazelton Ave-Stockton CA 95205-Phone: 209468-3420 <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH <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 2026 <br /> ❑ Amended Permit: "Change of0perator 'Change of Owner <br /> "Change of Operator Address *Change of Owner Address <br /> "Additional Employed <br /> State ID#: <br /> Please Note any Corrections or Changes in Facility/Operator Information directly oil this form. <br /> Site Name. STERLING FARMS LLC Location: 22220 N IIWY 99 ACAMPO <br /> Operator: STERLING FARMS LLC Email: <br /> Mailing Address: 17250 E KETTLEM_AN LN,LODI CA 95240 Facility Phone#: (209)401-5177 <br /> Legal Owner: BURNETT,TODD New Owner 7 ❑ Yes No <br /> Owner Address: 17250 E KETTLEMAN LN,LODI CA 95240 Owner Phone#: (209)401-5177 Email: <br /> Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ❑ No <br /> Men: Number of'Foilets NumberofShowers 2 4 1 r V6 Number of Lavatories 3 <br /> Women: NumberofToilets Number ofShowers Number ofLayatories <br /> Housina Accommodations to be Utilized this Year: Occupancy Dates: <br /> Buildings Employees � <br /> Dormitories from /I 12V to 12-/ 3 1/2 6 Crop t-1 V fsT'G('PC <br /> SF Dwellings from / / to / / Crop <br /> Apartments <br /> Owner Owned MH/RV Total Number of Days to be used this Calendar Year: 30 <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: -{=j- <br /> MH/RV Spaces Note <br /> TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year <br /> Require a PUBLIC WATER Sl'S'FEM 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 Bos and return this application. <br /> Fee Schedule <br /> Permanent Camp Annual Permit Fee $54.00+ Number of Employees { @$17.00 each=$ O O� <br /> ❑ Transfer of Ownership S25.00=S <br /> ❑ Permanent Amendment Fee S25.00+ Number ofAdditional Employees L S 17.00 each=$ <br /> ❑ Late Application Fee $108.00+ Number of Employees @$34.00 each=$ <br /> Fee must be submitted with Application <br /> TOTAL FEE DUE$ 13 1 .O O <br /> Remit TOTAL,FEE as CALCULATED ABOVE in the ENCLOSED Self-addressed Envelope <br /> MAKE CHECKS PAYABLE to EIID <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 AC`F,Chapter 1,Part 1,Division 13 of the California Health and <br /> Safety Cade and Chapter 1,Subchapter 3,Title 25,California Code ofRegulatious. Ig L/M IE-0 LIA 13/LI Ty <br /> Applicant Name C _ gU R AC—TT— Title ❑Partnership C 0 t)PAN y <br /> (Please PRINT or TYPE) ❑Corporation <br /> Address 17 ZS O E, lek7rLEMAN Ov LJ DI IA qs 2)o Phone 2_0 J L101 -S-1-77 <br /> Applicant Signature �' � �,; � Date of Application 1/1 I26 <br /> Amount Paid Date of Payment Payment Type hec eceipt# Received By <br /> I? 171 25 h£olt� 2 8-:3 <br /> Facility ID Program Record ID PIE Assigned to <br /> FA0027372 PRO547994 1765 Aaron Goodedtam <br /> Report#:7067.rpt <br /> NOV 0 4 2025 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />