Laserfiche WebLink
San Joaquin County-Environmental Health Department <br /> 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209468-3420 <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> ❑New Camp ❑Cnnditional Permit ❑ Multiple Yenrs(Permanent Housing Camps only) ®Annual Permit for Calendar Year 2023 <br /> ❑Amended Permit: "Change of Operator "Change of Owner <br /> •Change of Operator Address -Change of Owner Address Permit ED M 0026139 <br /> "Additional Employees <br /> State ID#: <br /> EH ID#: <br /> Please Note any Corrections or Qlgam cs til r rc rlirr Operator frrforalatrrm dh'eclIy on Am forts. <br /> Site Name; FRESH HARVEST INC Location: 4219 WATERLOO RD,STOCKTON <br /> Operator: GURROLA,ADRIAN <br /> Mailing Address: 101 E MAIN ST,HEBER CA 92249 Facility Phone#:(760)996-2252 <br /> Legal Owner: STEVE SCARONI New Owner? ❑Yes X❑ No <br /> Owner Address: 101 E MAIN ST,HEBER CA 92249 Owner Phone#:(760)996-2252 <br /> Commuuitv Facilirie%Provided Inv Cmmw- Community Kitchen? ❑ Yes ® No <br /> Men: NumberofToilets 5 NumberofShowers Number of Lavatories 5 <br /> Women: NumberofToilets Number of Showers Number of Lavatories <br /> H a uzinv A ecopi pindaria,ns to be Utilized this Vcnr• Occunnncv Darcy: <br /> 1luildines Emolavrts. <br /> Dormitories 1 25 from 4 l 2612{}23 to 1�0/30 12023 Crop Gallic <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 /> TOTALSCamps occupied by 25 or more Employees for 60 or more days in a year <br /> 25 Require a PUBLIC WATER SYSTEM Permit <br /> ❑Inactive <br /> Imnorbutt. 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 <br /> 0 Permanent Camp Annual Permit Fee S5000+ Number of Employees 25 $17.00 each=S $425.00 <br /> ❑ Transfer of Ownership $25.00=$ <br /> ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees a S17.00each=S <br /> ❑ Late Application Fee S100.00+ Number of Employees r;534.00 each=S <br /> Fee must be submitted with Application <br /> TOTAL FEE DUE 5 475.00 <br /> RemitTOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed Envelope <br /> MAKE CHECKS PAYABLE to EHD <br /> , r <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 <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code ofRegalations. <br /> Applicant Name Adrian Gurrola Title Housing Coordinator ❑Partnership <br /> (Please PRINT or TYPE) ❑Corporation <br /> Address 101 E Mzjiro.9t,lick er, CA 9??49 Phone 764-996-2-152 <br /> Applicant Signature Date of Application AoX,3 <br /> Amount Paid Dale of Payment Payment Type ChecklReceipt# Received By Account ID <br /> 0046122 <br /> Facility ID Program Record ID PIE Assigned to PWS ID <br /> FA0024661 PR0543451 2755 3611-GIRARDI N/A <br /> Report#:7066 Application Printed:312912023 <br />