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PgUla. SAN JOAQUIN COUNTY <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> ": , 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> /FOR PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: 47OD CITY: -iZAG q573 PA <br /> r <br /> OWNER NAME: �IZEWRL- tzE- 7-MU-57 DATE: <br /> APN: APPLICATION#: 5E— 110 54'4-;e DEPTH TO FIRST WATER: ti 3S Ft <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) <br /> It <br /> .._.......... _... _. _ LL - - - <br /> _.1.....__ _....._I _ <br /> ....... _ <br /> I I II _ _ 111�- ! I <br /> 1 <br /> E r I I ! I I <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil Type De th Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> Test Hole# 1 Test Hole# 2 <br /> Parcel: / Diameter: -4--,r in I Depth: +7— in Parcel: Diameter: in —' Depth: in <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> 00 r7& <br /> 3 <br /> 60 ' 2 �, <br /> 9.' 3 O 2.141 <br /> .2, 6o� <br /> 2. 7 <br /> PERCOLATION RATE: min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC A A: T RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: LV40i Phone: 1- Date 915 0 /:z <br /> TEST CERTIFIED BY: L Phone: Date <br /> OBSERVED BY(REHS): C cwt Phone DateT <br /> EHD 42-03 REV 11/2/09 PERC TEST RATE FORM <br />