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.,_,l Joaquin County-Environmental Health Department. <br /> 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209468-3420 <br /> APPLICATION <br /> ENVIRONMENTAL IIEALTII <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Ifousing Camps only) ❑Annual Permit for Calendar Year <br /> ❑Amended Permit: 'Change of Operator *Change of Owner <br /> 'Change of Operator Address *Change of Owner Address Permit ID H: 0027815 <br /> 'Additional Employees <br /> State ID H: <br /> Please Note any Corrections or Changes in Facility/Operalor Information directly on this form. EH IDH: <br /> Site Name: BONNIE PLANTS Location: 23975 E MILTON RD,LINDEN <br /> Operator: DE LA MADRID,MIGUEL <br /> Mailing Address: 23975 E MILTON RD,LINDEN CA 95236 Facility Phone#:(619)664-6921 <br /> Legal Owner: DE LA MADRID,MIGUEL New Owner? ❑Yes ❑ No <br /> Owner Address: 23975 E MILTON RD,LINDEN CA 95236 Owner Phone#:(619)664-6921 <br /> Community Facilities Provided by Camp, Community Kitchen? ❑ Yes ❑ No ' 1 <br /> Men: Number of'roilcLs Number of Showers ' - Number of Lavatories `1 <br /> Women: Number of Toilets Number of Showers Number of Lavatories <br /> HHousinsi Accommodations to be Utilized this Year: Occupancy Dates: <br /> BuildinEn F,mplovees 'j �y -1 Ka.0)-\ <br /> a <br /> Dormitories ` D from _/_/ to /_/ Crop <br /> SF Dwellings from /_/ to_/ / Crop <br /> Apartments <br /> Owner Owned MH/RV Total Number of Days to be used this Calendar Year: I �0 <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: <br /> MH/RV Spaces <br /> L`2tS <br /> TOTALS © Camps occupied by 25 or more Employees for 60 or more days in a year <br /> Require a PUBLIC WATER SYSTEM Permit <br /> ❑Inactive <br /> Important: In order to protect your land use status,ifcamp will not be used this year but is intended for use in the future,Check this Box and return this application <br /> Fee Schedule (� (� 0= <br /> I(Permanent Camp Annual Permit Fee S50.00+ Number of Employees `� 2$15.00 each=S `u <br /> ❑ Transfer of Ownership S25.00=S <br /> ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees C$15.00 each=$ <br /> ❑ Late Application Fee 5100.00+ Number of Employees a,$30.00 each=S <br /> Fee must be submitted with Application 2� 0 'U, <br /> TOTAL FEE DUE S l <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed Envelope <br /> MAKE CIIECKS PAYABLE,to EIH) <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 HOUSLNG ACT,Chapter 1,Part 1,Division 13 of the California Health <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code ofRegalarions. <br /> Applicant Name \ t v e t Title VLV8✓ <br /> PMership <br /> (Please PRINT or TYPE) <br /> r p, I❑Corporatition <br /> Address 'L'7jG�'l �•. I1`�"` �� Lttnaft^ Ci� �Sa3� Phone lP� I�rOwo- 6-la <br /> Applicant Signature 7 Date of Application 13 -L,� <br /> Amount Paid Date of Paym nt Payment Type Check/Receipt# Received By Account ID <br /> 0050073 <br /> Facility ID Program Record ID P/E Assigned to PyVS ID <br /> FA0026344 PRO546475 2765 8987-SANGALANG N/A <br /> Report#'7066 Application Printed:2/3/2021 <br />