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Example: <br /> BIG CAKE BAKER <br /> 51ackton CA 95209 <br /> Pe rm it#QY2345 <br /> Issued in: San Joaquin County <br /> Chocohiate Chip Cookies with Walnuts <br /> Ingredients Enriched flour(wheat flaur,niacin,redixed irorS thiamine,mononitrdte,ritaiftdviri <br /> and folic acid),butter(milk,salt),chat oW e c fi{x(sugar,floc olat:e liquor,cocoa burger,tur .erfat <br /> (milt),walnuts,sugar,efgr salt;artificial vanilla eiaraer traldrg scKa <br /> Contains: Wheat, milk,eggs, soy, walnuts, <br /> Made in a home kitchen <br /> Net Wt. 3 oz.. (85.05g) <br /> Note.For the'Issued in 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 /> 4public 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: C,I j -q o c H U n <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& <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 6/29/2023 4 CFO REGIPERMITTING FORM <br />