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a in_ SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> :� It L 600 East Main Street, Stockton, CA 95202-3029 <br /> '`1 Telephone=(209)468-3420 Fax:(209)d64-0138 Web:www.sjgov.orglehd <br /> �-oty PERCOLATION <br /> , TEST RATE <br /> ADDRESS OR LocAn �� L'1� �(1 -� c_�'1 e/ I/I �/C I'1U I arr: <br /> OWNER NAM ,7 I �y ch {'/�.I DATE: <br /> APN: I^,.�Z' - I j6q +,-A APPl1CAT1oN a: PA -l l n o c-� DEPTH TO FIRST WATER: Ft <br /> SDIL TYPE <br /> REMARKS: <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUCTURES <br /> _ PERCOLATION TEST SKETCH PERCOLATION TEST SKETCH <br /> 2-LV DIA.PVC PHTJ - _- Z-INDIAPVCIME _- <br /> A WDTA.SOR.RORTNO 4INDI.l SOU.RORINo = . <br /> T _ - <br /> +RRF�I�RiF7f RFFILLiINIK$:T ( <br /> SOIL PROFE F REQUIRED <br /> F-Depth I Soil Type 1 Depth I Soil Type I Depth I Soii T pe De h SoilType Depth Soil T <br /> Test Hole 01 Test Hole 0 2 <br /> Pamei: Diameter: In Depth: in Parcel: Dlameter: In Depth: in <br /> TIM'_ RE.VIING WATERDWP REFILLED TIME RENDING WATER DROP REFILLED <br /> _ 1 41, 111 <br /> c /- '- 3 <br /> ru . 2 <br /> r <br /> ro <br /> )r a -12 I/clO <br /> G <br /> PERCOLATION RATE: _ 3-�_---miWin PERCOLATION RATE:_ __ minlin <br /> RECOMMENDED SEPTIC EA _ RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: ' _ Phone: _,/t �=y Z- Date ji� <br /> TEST CERTIFIED BY: _ Phone: —12A-Of T Y Date <br /> n OBSERVED BY(RENS Phone �� -�y%�i Date <br /> EHD 42-03 REV 1 V2AI9 PERC 77:ST RATE FOTAI <br />