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<br />7. / Applicant's plan for clean up and material preservation (recycling) required <br />and attached. <br />8. _ Other provisions as may be required by this department: <br /> <br />9. STATE, COUNTY AND CITY HEALTH DEPARTMENT <br /> <br />Approved by: <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />1. _ Food and/or beverage served. <br />2. _ Pennit(s) attached. <br />3. Food cooked. <br />- <br />4. _ Pennit(s) attached. <br />5. _ List other health licensing obligations as may be require: <br /> <br />Page 10 oflO <br />