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PaDIN <br /> SAN JOAQUIN COUNTY RECEIVED <br /> I �O��'.COG <br /> �� ENVIRONMENTAL HEALTH DEPARTMENT uiJ 12 IUJL <br /> "; ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ': Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehc NVIRONMENTALHEALTH <br /> /POEN PERCOLATION TEST RATE PERMIT/SERVICES <br /> ADDRESS OR LOCATION: 'n. //'' ��/ CITY: <br /> OWNER NAME:_Cp-b AA AeA t-% 04& DATE:� 2— <br /> APN: APPLICATION M S2cz 6!;-P 6 B DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE:��. <br /> REMARKS: <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) <br /> /71� <br /> -Li:HpFfl- <br /> I <br /> . I <br /> I_ ...r L.._.��.... ...l�l �...._l�l..... .._.m__�I_...I �.---I�.....m m..... <br /> T�-1—I- <br /> -i--f <br /> SOIL PROFILE (IF REQUIRED) <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> 0- u <br /> r0� .z� <br /> Test Hole 1 Test Hole#2 <br /> Parcel: Diameter: in Depth: Parcel: Diameter: in I Depth: <br /> TIME READING WATER DROP REFILL TIMEREADING WATER DROP REFILLE <br /> C-0 by a.,O v k'/ <br /> 30 a . LAS D `3� G v <br /> v p , Z l5� Z (� <br /> v 2 331 <br /> b 3 <br /> b b16vl r <br /> p a - ' / 661 <br /> 0 — O 3 <br /> PERCOLATION RATE: min/in PERCOLATION RATE: (, minlin <br /> RECOMMENDED SEPTI REA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: Phone: -2-la-5090- Date 2 <br /> TEST CERTIFIED BY: Phone: ��q G6 3 2` Date0— <br /> OBSERVED BY(REH ): Phone 2A 7 4JF 12 X1'9 Date S' /< <br /> EHD 42-03 REV 11/2/09 PERC TEST RATE FORM <br />