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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Perm it#012345 <br /> saved rn: San Joaquin County <br /> Chocolate Chip Cookies with Walnuts <br /> Ingredterts Erroct ec flcu;wheatflmr.rtaor,reduced icor,tt Larree.- orcrKrate.ribcnaw, <br /> and f-dic acro,utter i^7A.salt.c ocoWecrtls Is6gar,crocdatehqucr,=ccabutter,buaerfat <br /> ImIKI,walrus.s:4ar,eggs.sal.artif oalvarilta e.trae,baarg scda <br /> Contains: Wheat, milk,eggs, soy, walnuts <br /> Made in a home kitchen <br /> Net Wt. 3 oz. (85.058) <br /> Noe For the"Issued to County'-Identify the jurisdiction(city/county)where you are obtaining approval <br /> 6. Disposal of Waste: <br /> Please check what type of treatment is used to dispose of waste <br /> ® Public Sewer Service ❑ Private Septic System <br /> In the event of septic system failure or plumbing problem,you are required to notify San Joaquin County Environmental Health <br /> Department immediately <br /> 7. Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box) <br /> ® Name of Public Water System or Community Services District City of Stockton <br /> ❑ Private Water Supply", Identify the source(well, spring, surface, etc.): <br /> Private Water Supply.Initial Water Quality Results <br /> Check boxes below if initial water testing has been completed <br /> All testing must be done at a State Certified Laboratory Either attach lab results or provide name of lab. date 8 <br /> results In space provided next to type of test <br /> "(Testing frequency for transient Non-Community Water Systems after initial testing) <br /> ❑ Bacteriological Test(quarterly'): <br /> ❑ Nitrate Test(yearly') - ---------- - ---- --- -- - ---------- <br /> EHD 16-27 6/292023 4 CFO REGIPERMITTING FORM <br />