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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Permit#012 345 <br /> Issued in: San Joaquin County <br /> Chocolate Chip Cookies with Walnuts <br /> Ingredients Enriched flour[wheatflour,rracir;reduced iron thiamine,monenitratq riboflavin <br /> andfolic acid),buttermilk,salt),chocolatechips(sugar,chocolate liquor,caaosbutter,butterfat <br /> (md4,wairxrts,sugar,eggs,salt artificialvanala extract,beldrg soda <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 /> dd 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 /> T Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box) <br /> + <br /> Er—Name of Public Water System or Community Services District Laf�t�D] <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)Von-Community Water Systems after initial testing) <br /> ❑ Bacteriological Test(quarterly'): <br /> ❑ Nitrate Test(yearly`): <br /> EHQ 16-27 6/2912023 4 CFO REGIPERMITTING FORM <br />