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San Joaquin County-Environmental Health Department 1868 E Hazelton Ave-Stockton CA 95205-Phone: 209468-3420 APPLICATION ENVIRONMENTAL HEALTH PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) ® Annual Permit for Calendar Year 2026 ❑ Amended Permit: *Change of Operator *Change of Owner *Change of Operator Address *Change of Owner Address *Additional Employees State ID#: Please Note any Corrections or Changes in Facility/Operator Information directly on this form. Site Name: THE ALMONDS Location: 11250 MICKE GROVE RD LODI Operator: THE ALMONDS Email: Mailing Address: 5252 BEAR CREEK RD,LODI CA 95240 Facility Phone#: (209)483-5395 Legal Owner: KAUTZ,JOHN New Owner? ❑ Yes No Owner Address: 5252 BEAR CREEK RD,LODI CA 95240 Owner Phone#: (209)3344786 Email: Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ra No Men: Number of Toilets Number of Showers Number of Lavatories Women: Number of Toilets Number of Showers Number of Lavatories Housing Accommodations to be Utilized this Year: Occupancy Dates: Buildings Employees Dormitories 2. from / / to / / 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: MH/RV Spaces Note TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year Require a PUBLIC WATER SYSTEM Permit ❑Inactive 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. Fee Schedule Permanent Camp Annual Permit Fee $54.00+ Number of Employees 7 @$17.00 each=$ ❑ Transfer of Ownership $25.00=$ ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$17.00 each=$ ❑ Late Application Fee $108.00+ Number of Employees @$34.00 each=$ Fee must be submitted with Application f7b TOTAL FEE DUE$ Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-addressed 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,Subchapt 3,Title 25,California Code of Re uI d ns. y s Applicant Name JO�� !v" /e,*,Vo t o �- ; L Title W �{,� ❑Partnership (Please PRINTorT1PE) /� ❑Corporation Address SZ-6-T 4• t�P•C G� �/'� L oo Phone ApplicantSignaturc / _ s hate ol'Application Arnount Paid ( Date of Payment Payment Type ChecWReceipt# Received By g 7b. n-6 I f 7 4-b1 S( _ 9 Facility ID Program Record ID PIE Assigned to PWS ID FA0027890 PR0548722 765 Aaron Gooderham Report#:7067.rpt HECEIVED NOVO ? ?025 SAN JOAQUIN COUNT Y ENVIRONMENTAL HEALTH DEPARTMENT