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Applications Will Be Pn J When Submitted Properly Completed. Be ; -i Sign The Application. Q OFFICE USE ONLY For Calendar Year 1995 a 7 d 7 / Area Multiple Years (Permanent Housing Camps) APPLICATION Conditional Permit Date Approved I.D. No. ��G 39-176 (For Non-Transferable, Revocable, Suspendable) Permit ENVIRONMENTAL HEALTH PERMIT Date Mailed _ TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP New Existing FEE IS DUE WITH APPLICATION Change Location 13959 E. Fanning Road- Stockton, Ca 95215 Operator VERNON G. GOGNA Address 13959 E. Fanning Road- Stockton, Ca 95215 Telephone No. 209-931-4392 Legal Owner VERNON G. GOGNA New Owner Yes "' No Address 13959 E Fanning Road - Stockton, Ca 95215 Telephone No. No. Employees Housed 30 Occupancy Dates From 4-24-95 To 6-15-95 Crop Cherries From To Crop Total Number Days Used This Calendar Year Total Days Ocupied by 25 or more employees • (Camps Occupied by 25 or more employees for 60 or more days require a public water system permits) Inactive — IMPORTANT. If this camp is not to be used this year but is intended for use in the future, this application is to be returned marked "Inactive" too protect your land use status. FEE SCHEDULE Permanent Camps Annual Permit $35.00 + No. Employees $12.00 each = _ `T Orchard Camps$95.00 Transfer of Ownership $20.00 Amend Permit $20.00 + Additional Employees ® $12.00 each = _ Late Application Penalty Fee $70.00 + Employees a $24.00 each = _ Applicant agrees to ail necessary inspections incident to issuance of permit to operate. Applicant apreee that this project 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, CCR. Please remit in the enclosed self-addressed envelope together with applicable fee. DO NOT SEND CASH. Date 3-15-95 Signed X �� T i t I e PARTNER Contact Environmental Health for information and application for a public water system posit. FOR DEPARTMENT USE ONLY Fees Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By Jan u 31 ❑ Joy 1 a Received B July uy 31 BILLING REMITTANCE S REMIT BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED AMOUNT FEE LESS P N _ PLUS TY OTHER OTHER AeCeiwd by I Date Receipt No. Permit No. Issuance Dale Ma1Md OeYwed APPLICANT—RETURN ALC COPIES TO: ENVIRONMENTAL HEALTH PERMITMERVICES P.O. BOX 388 Stockton, Ca. 95201 OFFICE ADDRESS EH-0250 (11/94) 445 N.SAN JOAOUIN ST.,STOCKTON,CA phone ( 2 0 9 ) 4 6 8-3 4 2 0 (NO MAIL IS RECEIVED AT THIS ADDRESS)