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%3MIY JVKI.ZUIN %+UUIY I Y <br /> 2•' -ter'- '`s 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 /> - x u PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: <br /> n� 1 �I <br /> CITY: <br /> OWNER NAME: DATE: <br /> APN: ��L I I 0 "Y"3 APPLICATION�: �',` V v D DEPTH TO FIRST WATER: <br /> SOIL TYPE:_sc"Pj <br /> REMARKS: <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) <br /> I ; I LO <br /> i t t <br /> �boIirl <br /> F! <br /> 1 T1 [j] <br /> • � i - I ` I I I i i <br /> I__ <br /> I i j j j i <br /> f <br /> ri f� 1 i i t'-.{�`r-• - - '-a - I -i.-.� ._ <br /> E <br /> It <br /> SOIL PROFILE (IF REQUIRED <br /> Depth , <br /> Soil Type Depth Soil Type Depth Soil T yk <br /> Type De th Soil Te Depth Soil Type <br /> S <br /> _ Test Hole # 1 Test Hole #2 _ <br /> Parcel: Diameter: IF'in Depth: in Frcel: Diameter: in De the in <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> y Hs bA o, L4.13I - <br /> _ o LI,yNs - <br /> 4a_" .0 --- <br /> 010-1 <br /> u L © 011 t --- - <br /> PERCOLATION RATE: $ �_ �min/in PERCOLATION RATE: minlin <br /> RECOMMENDED SEPTIC-4REA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: �.-� � _ f Phone: III -',m-4 -3-46 Date l I 1 2:) h`1 <br /> TEST CERTIFIED BY: Phone: Date _ <br /> OBSERVED BY(RENS): Phone Date H /Z Z <br /> EHD 42-03 REV 1112/09 PERC TEST RATE FORT <br />