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San Joaquin County-Environmental Health Department 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209468-3420 APPLICATION ENVIRONMENTAL HEALTH PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP ( ^/� ❑New Camp E] IXI Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) Annual Permit for Calendar Year Ot,�/0qJ4 ❑Amended Permit: *Change of Operator *Change of Owner l� *Change of Operator Address *Change of Owner Address Permit ID#• 0000040 *Additional Employees State ID#: 39-0054-EH EH ID#: 39000054 Please Note any Corrections or Changes in Facility/Operator Information directly on this form. Site Name: LINDEN ORCHARDS 39-54 Location: 21100 E FRAZIER RD,LINDEN Operator: A SAMBADO&SON Mailing Address: 8077 N TULLY RD,LINDEN CA 95236--961 Facility Phone#:(209)931-2568 Legal Owner: BOGGIANO FAMILY INTEREST New Owner? ❑Yes No Owner Address: 8077 N TULLY RD, LINDEN CA 95236--961 Owner Phone#:(209)931-3086 Community Facilities Provided by Camp Community Kitchen? ❑ Yes ❑ No Men: Number of Toilets (0 Number of Showers 4 Number of Lavatories Women: Number of Toilets Number of Showers Number of Lavatories Ilousing Accommodations to be Utilized this fear: Occupancy Dates: I3uildims 1?mplovices ^ r 1 Dormitories from 0�/M/�� ^1`` to l0�./31/Q'A Crop SF Dwellings from _/_/ to_/ / Crop Apartments Owner Owned MH/RV Total Number of Days to be used this Calendar Year: Owner Owned RR Cars Total Days Occupied by 25 or more Employees: bftiLILIPAI ME/RV Spaces Ngk EJVED TOTALS Camps occupied by 25 or more Employees for 60 or ays�p wear Require a PUBLIC WATER SYSTEM Ptsh►►it 1 0 1`('17?� ❑Inactive ;AN JOAQUIN COUNTY Im on rtant: 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 thys ltlf6ncAL PARW1Iw r Fee Schedule -- Permanent Camp Annual Permit Fee $50.00+ Number of Employees � @$17.00 each=$ 9K0•DO ❑ Transfer of Ownership $25.00=$ ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$17.00 each=$ ❑ Late Application Fee $100.00+ Number of Employees @$34.00 each=$ Fee must be submitted with Application o0 TOTAL FEE DUE$ "I Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed Envelope MAKE CHECKS PAYABLE to EHD Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project(camp)shall be operated and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT,Chapter 1,Part 1,Division 13 of the California Health and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulations. `1 Applicant Name LA(` MJGE ,IAmSAI)b Title %E5r OWNER partnership (Please PRINT or TYPE) Corporation Address /"I q 5 Phone 10Q Q 3 Applicant Signature Date of.Application Amount Paid to of P yment Payment Type Check/Receipt# Received B Account ID , v� �jr� � 0000031 7FA cility ID L Program Record ID PIE '[ Assigned to PWS ID 000031 PR0270054 2765 0039-GOODERHAM WA0515762 Report#:7066 3�O Application Printed:11/1/2023