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"ANOAQUIN COUNTY • PUBLIC HEALTH .__ES / f ENVIRONMENTAL HEALTH DIVISION 304 E WEBER AVENUE • THIRD FLOOR • STOCKTON CA 95202 • Phone: 209/46P Why I v+v APPLICATION RECEIVED ENVIRONMENTAL HEALTH PERMIT TO OPERATE JAN 13 2000 EMPLOYEE HOUSING OR LABOR CAMP SANJOAQ(JiNW ❑New Camp ❑Conditional Permit Annual Pepe7e:nn PYSVf( � ❑Amended Permit ❑Multiple Years(Permanent Housing Camps only) ove —� • Change of Operator -Change of Owner d: • Change of Operator Address • Change of Owner Address 001462 • Additional Employees # 39000176 Please Note an Corrections or es in F IO erator/Owner I ormado�ngdiir9ect) on this form. Site Name: GOGNA,VERNON 39-176 Location:) HE'S E FANNING RD Operator: GOGNA,VERNON ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Mading Address: 13959 E FANNING RD,STOCKTON CA 95215 Facility Phone#: 209-931-4392 Legal Owner: GOGNA,VERNON New Owner []Yes ),fiJNo' Owner Address: 13959 E FANNING RD,STOCKTON CA 95215 Owner Phone M 209-931-4392 Community Facilities Provided by Camp: Community Kitchen: ❑ Yes ❑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: Buildinas Employees Buildings Employees Dormitories: Owner Owned MR/RV SF Dwellings Owner Owned RR Can Apartments MH/RV Spaces TOTAL of Both COLUMNS Occupancy Dates: from to_k_/15/00 Crop Cherries Total Number of Days to be used this Calendar Year from / / to / / Crop Total Days Occupied by 15 or more Employees — ——— Note: Camps occupied by 15 or more employees for 60 or more days a year require a Pubfic Water System Pere & ❑ Inactive Imsottasst' In order to protect your land use status,ifcamp will not be used this year but isiatasdedfor use in fhe,fthwr Check this Box and return this appl/cadm Fee Schedule ❑ Permanent Camp Annual Permit$35.00+Number of Employees $12.00 each=$ _ lR Orchard Camp Pertnit Fee=$95.00=$ 95.00 ❑ Transfer of Ownership=$20.00=$ ❑ Permit Amendment=$20.00+Number of Additional Employees $12.00 each=$ ❑ Late Application Fee$70.00+Number of Employees @,$24.00 each=$ Fee must be submitted with Application TOTAL FEE DUE: 95.00 REMIT TOTAL FEE AS CALCULATED ABOVE IN THE ENCLOSED self-addressed ENVELOPE. M4AF CHECXSPAYABLB TO: PHS/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 Health and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of ftuladons. Applicant Name VERNON GOGNA Title Partner Z Partnership ❑Corporation (PleasePRlA/I'or7YPE) Address JA959 E. Fanniqg Road, Stockton, CA 95215-9730 Phone(209)931-2664 Applicant Signature - Date of Application 01/10/00 Program Record ID# 270176 Fac0lty ID# 001464 Account ID# 0001463 Date pf prilnent Payme t# I Recely Py • Employee#: c #: ac ID: PR#: PWS OW P/E: