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SR0083251
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083251
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Entry Properties
Last modified
6/15/2021 11:00:57 AM
Creation date
6/15/2021 10:53:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083251
PE
4222
FACILITY_NAME
23110 N DUSTIN RD
STREET_NUMBER
23110
Direction
N
STREET_NAME
DUSTIN
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
00705013
ENTERED_DATE
2/8/2021 12:00:00 AM
SITE_LOCATION
23110 N DUSTIN RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Tags
EHD - Public
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Site Address: 23110 E Jahant Rd, Acampo CA 95220 <br />Date: 4/21/2021 <br />PHOTO # 1 Perc Test <br />Record ID: SR0083251 <br />tn av<VD-OLJL -K v\ <br />Telephone: (209) 466-3420 Fax: (2--"--. Web: wWN *j9ov.nr9,ehd - <br />PERCOLATION TEST RATE 4ti <br />: ADDRESS OR LOCATIONZ�I I0 <br />r <br />} <br />OWNER NAM_:---L <br />_s±�_CnY <br />iA <br />APN: 0z DATE: <br />D�3__APPI-(CATIONM: 5 <br />Aw SOIL TYPE ROOS3 SI DEPTH <br />TO <br />FIRST <br />� WA T <br />�."�• <br />v <br />Ft' •yam <br />J <br />. ` --- - LOCA <br />I STRUCTURES( <br />/ I Y TION OF TEST HOLES sHow WELLS AND -- <br />' I <br />Vr <br />_jr <br />A11- <br />�* <br />I <br />f4 ICiIll L! I <br />F <br />ILi.CO I' L r r <br />E Il-- ]a:rs <br />1 <br />i <br />�.- SOIL PROFILE LF REQUIRED) � <br />De ih Soil Tv e Depth Soil T e - ,i <br />Type Ueoth <br />— -.. SCsITyFE Ueath I Soil T <br />¢� -- _ .Test Nole # <br />n D_DL . I r0 E Diameter ( <br />FarceP. --r - <br />m enm� <br />06 _0 i. S_�=I I N S3__ 4 h -._ RJc_' ws-EroPu 1_ 4`aLeu <br />c - 3'Z-_ (_4 ct6 Olt( 4 <br />—— — <br />v oo IS I� I I 5G_ _9 >z-- 4 -- <br />10'7U I� ) � LF <br />i <br />_ - <br />L/ � -- <br />-L47ION RATE: --- -- -- -_ <br />MENDED SEPTIC A —miNin PERGOLA ryON I <br />RATE: <br />'FORMED Dy. RECOMMENDED SEPTIC <br />- AREA: <br />ERTIFIED &Y• PhgnS; 2tn 36,q _ 03 �r- <br />:Y-F�oY�REhISi i--- PhorE. Jate L 1 <br />Fe zu, �tC`141��i j_L' - Phone I DD'_ 1. <br />i'f L_ ,. Date 1%I it <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />
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