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PAYMENT RECEIVED San Joaquin County-Environmental Health Department 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209468-3420 AUG 0 7 2025 awe.rfvE+Quln Cvun I T APPLICATION ENVIRONMENTAL ENVIRONMENTAL HEALTH HEALTH DEPARTMENT PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP ❑New Camp ❑Conditional Permit ❑ Multiple Yea rs(Permanent Housing Camps only) Annual Permit for Calendar Year Z OZ S- ❑Amended Permit: *Change of Operator *Change of Owner *Change of Operator Address *Change of Owner Address Permit ID#: 0010991 *Additional Employees State H)#: EH ID#: 39000345 Please Note any Corrections or Changes in Facility/Operator Information directly on this form. Site Name: FRANK N ROCHA DAIRY LP#1 39-345 Location: 23243 E LONE TREE RD,ESCALON Operator: ROCHA,FRANK N -ZPN Mailing Address:2'311L E LONE TREE RD,ESCALON CA 95320 Facility Phone#: I6 Z- C1, Ck Legal Owner: ROCHA, FRANK N AND KATHY,SILVA,JOHNNY,&MEGAN New Owner? ❑Yes ® No 1 Owner Address:'2.3ZyA*E LONE TREE RD,ESCALON CA 95320 Owner Phone - Community Facilities Provided by Camp: Community Kitchen? ❑ Yes No Men: Number of Toilets Number of Showers Number of Lavatories Women: Number of Toilets 96 Number of Showers Number of Lavatories Housing Accommodations to be Utilized this Year: Occupancy Dates: Buildings Employees Dormitories from A—/%L& to[Z /31 / Z.S Crop SF Dwellings from _/_/ to_/_/ Crop Apartments Owner Owned ME/RV Total Number of Days to be used this Calendar Year: 3V� Owner Owned RR Cars Total Days Occupied by 25 or more Employees: Cj ME/RV Spaces Note TOTALS I—iZJ Camps occupied by or more Employees for 60 or more days in a year Require a PUBLIC WATER SYSTEM Pet•mit ❑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 9'r5@+@@-v3 2. Number of Employees @$17.00 each=$ ( VP•00 ❑ Transfer of Ownership $25.00=$ ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$17.00 each=$ ❑ Late Application Fee $100.00+ Number of Employees @$34.00 each=$ Fee must be submitted with Application TOTAL FEE DUE$,g b•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. Title �a� ,(` Partnership Applicant Name (Please PRINT or TYPE) ❑Corporation Address 'off Phone(2j1h S 2-W-19 R Applicant Signature Date of Application C 5—ZpZS Amount Paid'1 as e t Payment Type rn/ehe Recteiprt�# Received By Account ID O�O• �V �- 1��Z� l.. UCt{��1�11�� 0002937 [�FA0003360 cility ID �Pregram Ranerd-ID` PIE Assigned to PWS ID PRO515635 2765 9852-SALINAS WA0515607 Report#:7066 �� 2� T7 � v1 ApplicationPrinte 6!2/2025