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via"I.M••g 'SAN JOA <br /> ,�•e,,,,�.•,o QU1N COUNTY <br /> NENVIRONMENTAL HEALTH DEPARTMENT <br /> , :. I i <br /> 1868 East Hazelton Avenue Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209 464-0138 Web: <br /> �,�."�'S''='�a•• ) www.sjgov,org/ehd <br /> �'%FORS <br /> —� a'I PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: L(l� 1 ��t+C, P[.r, <br /> CITY: <br /> OWNER NAME:._ [�l<rel la�j�'1-t'7 0 <br /> DATE: I���"v�t!'•� <br /> APN: �� - I�U"-�7 APPLICATION#: )�s`09r�,c� <br /> SOIL TYPE: DEPTH TO FIRST WATER: Ft <br /> REMARKS: <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUCTURES) <br /> -- I—._....... i i___ <br /> _1 ++ <br /> e - <br /> , <br /> 3 — <br /> I— . <br /> - - P : r <br /> — — — — <br /> I i t i� i 1 __.i �i'—i i i�.• Ff <br /> _ <br /> ._� . T- 9...__~i - 9........� �...:...�_r_1,- �::-,,.�._�.......,., �_.,..1-71 A,�_ <br /> F! _ �l 1 I-9 1 f I I-@ <br /> 33 <br /> _ I <br /> SOIL PROFILE (IF REQUIRED) <br /> De th Soil T e Depth Soil Type Depth Soil T e De th Soil Type Depth Soil T e <br /> Test Hole# 1 Test Hole #2 <br /> Parcel: Diameter: �3 in De the ,-! if, Parcel: Diameter: _ in De the 2- in <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> (2 <br /> -7 <br /> -- /�] \ /VA+O ,� - <br /> 0 ° 0 — Z . A.� <br /> PERCOLATION RATE: minlin PERCOLATION RATE: 31,3 <br /> RECOMMENDED SEPTIC AREA:- minlin <br /> RECOMMENDED SEPTIC AREA: <br /> TES7PERFORMED BY: _�G2 1>1�;, �'v�o Phone: Date <br /> TEST CERTIFIED BY:. I r , I Phone: _ Date <br /> OBSERVED BY(REFIS): ✓� % '• Phone_ 0�J Date <br /> EH 42-03 REV 11/2/09 ! �1 IV , <br /> 1 PERC TEST RATE FORM <br />