Laserfiche WebLink
• 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 of Operator "Change of Owner <br /> "Change of Operator Address "Change of Owner Address <br /> "Additional Employees <br /> State ID#:39-0054-EH <br /> Please Note any Corrections or Changes in Facility/Operator Information directly on this form. <br /> Site Name: LINDEN ORCHARDS 39-54 Location: 21100 E FRAZIER RD LINDEN <br /> Operator: LINDEN ORCHARDS 39-54 Email: <br /> Mailing Address: 8077 N TULLY RD,LINDEN CA 95236-9619 Facility Phone#: (209)931-2568 <br /> Legal Owner: BOGGIANO FAMILY INTEREST New Owner? ❑ Yes NrN. <br /> Owner Address: 8077 N TULLY RD,LINDEN CA 95236-9619 Owner Phone#: (209)931-3086 Email: <br /> Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ❑ No <br /> Men: Number of Toilets Number of Showers Number of Lavatories (p <br /> Women: Number of Toilets Number of Showers Number of Lavatories <br /> Housine Accommodations to be Utilized this Year: Occupancy Dates: <br /> BuildinEs Employees n / <br /> Dormitories 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: <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: <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 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 $54.00+ Number of Employees 1� @$l 7.00 each=$ !/�ye <br /> ❑ Transfer of Ownership $25.00=$ <br /> ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$17.00 each=$ <br /> ❑ Late Application Fee $108.00+ Number of Employees @$34.00 each=$ <br /> Fee must be submitted with Application TOTAL FEE DUE$JWP , <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-addressed 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 and <br /> Safety Code and Chapter 1,S chapter 3,Title 25,C rnra Code ofRega Lions. <br /> Applicant Name �>(�rL�wG �� Title ,v ❑Partnership <br /> (Please <br /> PRINT orTYP ---���EEE _ o Or ti n <br /> Address � � � Ol o <br /> Applicant Signature Date ul'Application <br /> Amount Paid Date of Payment Payment Type Check/Receipt# Received By <br /> cl -C'� <br /> Facility ID Program Record ID PIE Assigned to PWS ID <br /> A0000031 PR0270054 765 Aaron Gooderham <br /> Report#:7067.Ipt PAY M E N T <br /> RECEIVED <br /> DEC 2 2 2029 <br /> aAN JOAOUIN COUNrY <br /> ENVIRONMENTAL <br /> �o ALIHU TARJMUN' <br />