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v' <br /> O ° D <br /> CL <br /> I � o rD <br /> VI LA <br /> O O <br /> M O 00 <br /> < ,�.f 00 <br /> .a.:.Y O <br /> :3 .-,.- ENVIRONMENTAL HEALTH DEPARTMENT -1 rt <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 M n <br /> Telephone:(209)468.3420 Fax:(209)464-0138 Web:www sigov crglehC <br /> v <br /> F, <N O <br /> PERCOLATION TEST RATE cD <br /> (D ADDRESS OR LOCATION: <br /> OWNER NAME'. J�Ii R. DATE; ` <br /> APN; - .-(1O'I(f _APPLICATION N: 1 A -I�:?.r.'1-T i DEPTH TO FIRST WATERS <br /> N SOIL T)'PE F Ln L(/ n <br /> (D REMARKS: <br /> Nr LOCATION OF TEST HOLES(SNOW WELLS AND STRUCTURES) <br /> ror fE <br /> - - <br /> rD <br /> -L - ; <br /> i <br /> IT <br /> 1 I I I <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil Type De th Soil Type Depth I Soil T e Depth Soil lye- <br /> Test <br /> eTest Hole#1 Test Hole#2 <br /> Parcel' r Diameter: =; 4 in Depth: = in Parcel: Diameter. n Depth. n <br /> I TIME READING (NATER DROP REFILLED TIME READING WATER DROP RE=1'-E <br /> 30 , S' i o <br /> 00 0, 3 <br /> -�o <br /> 00 <br /> I <br /> minlin <br /> PERCOLATION RATE: : minlin PERCOLATION RATE: <br /> RECOMMENDED SEPTIC A: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: Phone: - o - Date '7-10-l! <br /> �9 <br /> Date <br /> Phone: (D <br /> TEST CERTIFIED BY: - !4" /I' o <br /> Phone Date <br /> OBSERVED BY(REHS): I O 00 rt j O�r}c,=STRATEFORM <br /> EHD 42•03 <br /> REV 11/2,C9 [S `�'J <br /> t/1 <br /> 0 <br /> 0�q r O <br /> I. O <br /> N - 00 <br /> O 4�- <br /> F,, <br />