Laserfiche WebLink
San Joaquin County-Environmental Health Department <br /> c <br /> t 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209-468-3420 1 <br /> APPLICATION <br /> ENVIRONINIENT.AL HEALTH <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> ❑Nev Camp [:]Conditional Permit ❑ Multiple fears(Perm meu Housing Camps only) Annual Permit for Cnlendar Year <br /> ❑Amended Permit: -Change or0perator "Changeof Owner <br /> "Change of Operator Address "Change of Owner Address Permit ID#.• 0027507 <br /> 'Additional Employees . <br /> State ID 9: <br /> EH ID#: <br /> Please.Vote any Corrections or Changes in f'acility10perator hr(ornration directly on rlus form. <br /> Site Name: BARRERA MALDONADO PROPERTIES LLC Location: 1108 ROSE MARIE LN,STOCKTON <br /> Operator: BARRERA,LUIS <br /> plaiting Address: 17450 AVENIDA LOS ALTOS,SALINAS CA 93907 Facility Phone#:(831)272-3523 <br /> Legal Owner: BARRERA,EDGAR Now Owner? ❑Yes ❑ No <br /> Owner Address: 17450 AVENIDA LOS ALTOS,SALINAS CA 93907 Owner Phone#:(831)272-3523 <br /> Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ❑ No <br /> Men: Number of Toilets �ILANumber of Showers 9 tA Number of Lavatories I N <br /> Women-. Number of Toilets Number of Showers Number of Lavatories <br /> Housing Accommodations to he Utilized this Year: Occunancv Dates: <br /> Buildings Emnlm•ees �1� �� <br /> Dormitories from ON /01/ LS to iZ/�P / ZS Crop l.rKr�C3 .1t;7ri�0 , <br /> SF Dwellinas from _l_I to_1 / Crop <br /> Apartments- I N i10 <br /> Owner Owned NIH/RV Total Number of Days to be used this Calendar Year: <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: <br /> 1 H!RV Spaces Note <br /> � Camps occupied by 25 or more Employees for 60 or more days in a year <br /> TOTALS � I 0 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 /> Vl;� Fee seheante ap <br /> ecrnancnt Camp.Annual Pennit Fee t58:�C'- Number of Employees 130g?517.00 each=S Z�Z�� <br /> ❑ Transfer of Ownership S25.00=S <br /> ❑ Permanent Amendment Fee S25.00+ Number of Additional Employees t S 17.00 each=S <br /> ❑ Late Application Fee S 100.00_ Number of Emplovecs n.$34.00 each=S <br /> Fee must be submitted with Application --- <br /> TOTAL FEE DUE 5 � Z�a2,._0� <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed Envelope <br /> NJAKE CHECKS PAYABLE to EHD <br /> Applicant agrees to all necessary inspections incident to issuance or 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 Califonia Health <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25.California Code of Regulations. <br /> Applicant Name fV 15 �„( ioe - Title _ mvi,n/iri0� ❑corpoPartneration <br /> (Please PRINT or TYPE) <br /> t (y� c l /� p�.,�� ❑COIpOrall0ll <br /> Address ��"l� A(�/er 1d L(,6 r1�� .)L�i YlLls l A lS 1V 1 Phone ( .�' 7a JS?3 <br /> Applicant Sig a Date of Applicatiou I Z Z.(Q'2� <br /> Amount Paid Date of Payment Pay m ype Check/Receipt# Received By Account ID <br /> 0049219 <br /> Facility ID Program Record ID PIE Assigned to PWS ID <br /> FA0025974 PRO545931 2755 9852-SALINAS N/A <br /> Report#.7066 Application Printed 10126/2024 <br />