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12/23/2003 13:22 464013R ENVIRONMENTAL HEALTH PAGE 02 <br /> ` an Joaquin County-Environmental Health Depart. .c <br /> 304 E Weber Avenue-Third Floor-Stockton CA 95202-Phone: 209-468-3420 <br /> � \ 1 <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> ❑New Camp ❑Conditinnal Permit ❑ Mlultipie Years(Permanent Housing Camps only) ❑Annual Permit for Calendar Year C;��0 <br /> ❑Amended Permit: 'Change of Operator *Change of Owner <br /> "Change of Operator Address *Change of Owner Address <br /> *Additional Rniployees <br /> Permit TD#: 0000040 <br /> Please Note any Corrections or Changes in Facilityl0prratnr Information directly on this Camp to#: 39000054 <br /> Site Name: LINDEN ORCHARDS 39-54 Location: 21100E FRAZIER RD,LINDEN <br /> Operator: i P I It'h b`.�.0'� SOA <br /> Mailing Address: 8077 N TULLY RD,LINDEN CA 95236 Facility Phone#:(209)931-2568 <br /> Legal Owner: BOGGIANO FAMILY INTEREST Nrw Owner' ❑Yes No <br /> Owner Address: 7899 N DE MARTINI LN,LINDEN CA 95236 Owner Phone 9:(209)931-3086 <br /> Community Facilities Provided 'amp: Community Kitchen 7 0 Yes ❑ No <br /> l <br /> Men: Number of Toilets K Number of Showers Number of Lavatories , <br /> Women: Number of`roitets Number of Showers Number of Lavatories <br /> Houiirkp Accommodations to be UtiljM this Year: Occupancy Dates: / <br /> Buildings. Employees h tyyt'w <br /> Dormitories from �/ � ! 0�to l f l � l � � Crop <br /> SF Dwellings from _/_/ to_/i/ 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 am <br /> TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year <br /> Require a P1I8LIC 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 appli<anon. <br /> Fee Schedule`' 0 <br /> ❑ nermancot Camp Annual Py mit Fe $35.00+ Number of Employees �! C $12,00 each=$ <br /> ❑ Orchard Camp Permit Fee $85.00-$ <br /> ❑ Transfer of Ownership $20,00=R <br /> ❑ Permanent Amendment FCC $20.00+ Number of Additional Employees @$12-00 each_S <br /> ❑ Late Appl icatian Fee $70.00+ Number of Employees @$24.00 each=$ <br /> Fee must be submitted with Application TOTAL FEE DUE S <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed Envelope <br /> MAKE,CHECKS PAYABLE to F..HD <br /> Applicant agrect to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this proieet(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 <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25,California Cade of Regulations- <br /> / ny ��� 'T'itle El Partnership <br /> Applicant Name /(t2 4Aj Yt yl —. Cur-pwwation <br /> (Please PRINT or rYPE) <br /> Address Q tAy 7 t�C <br /> Applicant Signature ' Date of Application <br /> 1�►�rr � ?kG�Lle� T I D <br /> p.61? ,�,��Dy y �344g ,/ �R <br /> 6, e-Iq IL965I <br /> Appllcoifon Printed:12/23/2003 <br /> Revort#:7066.0 �.E A t Gx D To F LO 5 1 D <br /> �KDGI> 4MW ID <br /> �'�Beovo g� �ii t�o27�jc5'y �276�'' <br />