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Example: <br />BI G CAKE FAKER <br />ChoccIP:te Ct-ip Cookies wi:n <br />: <br />Note.- For the "Issued in County"- Identify the jurisdiction (city/county) where you are obtaining approval. <br />Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />Public Sewer Service El 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 />Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />g Name of Public Water System or Community Services District. Mountain house CSD <br />111 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 & <br />results in space provided next to type of test. <br />*(Testing frequency for transient Non-Community Water Systems after initial testing) <br />111 Bacteriological Test (quarterly"): <br />Nitrate Test (yearly*): <br />EHD 16-27 6/29/2023 4 CFO REG/PERMITTING FORM