COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

San Joaquin County-Environmental Hcalth Department 1868 E.Ilazelton Avenue-Stockton CA 95205-Phone: 209-468-3420 APPLICATION ENVIRONMENTAL.HEAL1-II PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Rousing Camps only) ©Annual Permit far Calendar Year 2026 ❑Amended Permit: -Change of Operator 'Change of Owner 'Change of Operator Address 'Change of Owner Address Permit ID 4: -Additional Employees State ID 4: EH Ill N: Please Note any Corrections or Changes in Facility/Operator hifonnalton directly on this form Site Name: WATERLOO INN Location: 3951 BUDWEISER CT,STOCKTON Operator: FRESH HARVEST,INC. Mailing Address: 101 E MAIN ST,HEBER CA 92249 Facility Phone 4:(760)791-5114 Legal Owner: KHUSAL.MEERAN New Owner p ❑Yes ® No Owner Address: 101 E MAIN ST,HEBER CA 92249 Owner Phone 4:(760)996-2252 Community Facilities Provided by Camp: Community Kitchen" ❑ Yes ❑X No Men: Number of Toilcts 5 Number of Showers 5 Number of Lavatories 5 NVomen: Number of Toilets Number of Showers Number of Lavatories Housing Accommodations to be Utilized this Year: Occupancy Dates: Buildings Empl—ees Dormitories 1 20 from 04/01/_2026 to 12/ 31/2026 Crop Garlic SF Dwellings from_I_/ 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: MII/RV Spaces Note TOTALS 20 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 X❑ Permanent Camp Annual Permit Fee $50.00+ Number of Employees 20 ([u 517.00 each=S $340.00 ❑ Transfer of Ownership 525.00=S ❑ Permanent Amendment Fee $25.00+- Number of Additional Employees (r`u,$17.00 each=S ❑ Late Application Fee 5100.00+ Number of Employees (a$34.00 each=$ Fee must be submitted with Application TOTAL FEE DUE$ $390.00 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. Applicant Name SALOME RAMIREZ Title H2A MANAGER ❑Partnership (Please PRINT or TYPE) ®Corporation Address 101 E MAIN ST,HEBER,CA @2249 Phone 760-791-51 14 :Applicant Signature --r Date of Application 03/9/2026 Amount Paid Date of Payment Payment Type Check/Receipt 4 Received By Account ID Facility ID Program Record ID PIE Assigned to PN/S ID FA0024661 �" -� alta, `iltti�;t-LtE'AYMEN MARi 6 7"I lication Printed:3/29/2023 Report 4.7365 SAN JOAOIIIN COl1Nl', ENVIROnr.iENIAI