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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Perm itb 0112345 <br /> issued in: San Joaquin County <br /> Chocolate Chip Cookies with Walnuts <br /> ingredients.En6&ed flc�,r Ir,FeatfloLr,riacir,reduced iron,thiamire,moronitrate,ribr-flaon <br /> and felic acid;t,butter Irrilk,said,chocolate chips Is+.-gar,chocdate ligi,er,cocoa butter,butterfat <br /> Imilkl,walnuts,sugar,egg;,salt,artificial"arilla earact,ta+6rg 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 /> 4 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 Heafth <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: <br /> ❑ Private Water Supply", Identify the source (well, spring, surface, etc.): I <br /> Private Wafer 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 16-27612912023 4 CFO REGIPERMITTING FORM <br />