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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95204 <br /> Permit#012345 <br /> Issued in: San Joaquin County <br /> Chocolate Chip Cookies with Walnuts <br /> IrVedierlts Enridted nw(wheat nco.riadr;reduced ImR thiamnG maxnkraq riboflavin <br /> a wfdic acid,butter[mid,s44,dromlicechipc[sugar,d,«daelkwr,mmabutter,b=wfas <br /> (mild,vjWnut%s;s eW;salt,a ti lvanilaepuacr balaresoda <br /> Contains,Wheat,milk,eggs,soy,walnuts <br /> Made in a home kitchen <br /> Net Wt.3 oz.(95.059) <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 /> ® 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 /> 5&Name of Public Water System or Community Services District: st 4w Lin VVA <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 />