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oto•"f" o SAN .10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .y <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> i" Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ��FOR PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: �yUj*'' '14L/14"'yJewv CITY: 64t-,r <br /> OWNER NAME: DATE: -• 7r??e <br /> APN: �" �0 ' C!7 '���''��� APPLICATION#: 7y DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> i <br /> I ' <br /> € _ <br /> i <br /> 1 = liti# <br /> e <br /> I _ <br /> a <br /> L <br /> -1-1 F-T-1 it-'tll�i . I(-!-1 I�__.Tl C1_. F-1 _l FT=�1 1 I-9-1 . <br /> i I <br /> , <br /> , <br /> i <br /> s <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil TVpe Depth Soil Tvpe Depth Soil Type Depth Soil Type Depth Soil Type <br /> Test Hole # 1 Test Hole#2 <br /> Parcel: Diameter: ,f; in I Depth: ?- in Parcel: Diameter: in I Depth: in <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> .9n '� Za , <br /> 21 ,07 <br /> 00 .07 <br /> 07 <br /> ad9 ,ob ?-4�v <br /> PERCOLATION RATE: min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: Phone: Date " Zo <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY (REHS): ( ,� ~ `L. Phone Date <br /> EHD 42-03 REV 1112/09 PERC TEST RATE FORM <br />