BILLING - Laserfiche WebLink

Home Browse Search

PAYMENT RECEIVED San Joaquin County-Environmental Health Department 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209468-3420 AUG 2 n 2022 SAN JOAQUIN COUNTY APPLICATION ENVIRONMENTAL ENVIRONMENTAL HEALTH HEALTH DEPARTMENT PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) Annual Permit for Calendar Year 20 2 ❑Amended Permit: "Change of Operator "Change of Owner "Change of Operator Address "Change of Owner Address Permit ID# 0022183 "Additional Employees State ID#: 39-15855-EH Please Note any Corrections or Changes in Facility/Operator Information directly on this form EH ID#: 39000430 Site Name: RIPON FARMS 39-430 Location: 23531 S JACK TONE RD, RIPON Operator: HOGAN,THOMAS P Mailing Address: 1532 SCENIC DR,MODESTO CA 95355 Facility Phone#:(209)492-9335 Legal Owner. HOGAN,THOMAS P New Owner? ❑Yes [21 No Owner Address: 1532 SCENIC DR,MODESTO CA 95355 Owner Phone#:(209)604-5280 Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ❑ No Men: Number of Toilets n/a Number of Showers Il/a Number of Lavatories n/a Women: Number of Toilets n/a Number of Showers n/a Number of Lavatories n/a Housing Accommodations to be Utilized this Year: Occupancy Dates: Buildings Employees Dormitories from 1 / 1 /202k 12/31/2022 Crop Varies SF Dwellings from _/_/ to_/_/ Crop Apartments 8 8 Owner Owned ME/RV Total Number of Days to be used this Calendar Year: 365 Owner Owned RR Cars Total Days Occupied by 25 or more Employees: 0 MH/RV Spaces N914 TOTALSCamps 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 f77 0 U Permanent Camp Annual Permit Fee $50.00+ Number of Employees 8 @$3��each=$ 13 6 . 0 0 ❑ Transfer of Ownership $25.00=$ ❑ Permanent Amendment Fee S25.00+ Number of Additional Employees @$15.00 each=$ ❑ Late Application Fee $100.00+ Number of Employees @$30.00 each=$ Fee must be submitted with Application TOTAL FEE DUE$ 18 6 . 0 0 Remit TOTALFEE 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 appliaqa blrovisions of the EMPLOYEE HOUSING ACT,Chapter 1,Part 1,Division 13 of the California Health and Safety Code and Chapter u6c apter 3 C i de of Regulations. Applicant Name �� s j Title Owner El Partnership (Please PRINT orTYPE) ElCorporation Address 1207 13thS-t. St /qModesto CA 95354 Phone (209) 492-9335 Applicant Signature e-�l� Date of Application 7/15/2 0 2 2 AmountPaidDate of PPatyment v Payment Type Ch Receipt# Received By Account ID 1 l�C 601 �— 1 �� 0 NU 0037333 Facility ID Program Record ID PIE Assigned to PWS ID FA0020798 PR0536203 2765 0039-GOODERHAM N/A Report#:7066 Application Printed:7/14/2022