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o o L! <br /> = rt m <br /> �O r>? D <br /> h 4GIN SAN JOAQUIN COUNTY CL <br /> O ,Qn . <br /> ENVIRONMENTAL HEALTH DEPARTMENT N N <br /> aa) ` 1868 East Hazelton Avenue,Stockton,CA 95205-6232 N `" <br /> af' F. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd n ON No <br /> O <br /> � PERCOLATION TEST RATE N <br /> O ADDRESS OR LOCATION: 0 I I W°l�1�� r CITY: L-;A d-P Y1 3 mmC <br /> 7 1 <br /> 3 OWNER NAME: L2..(0.Y�c� Mzt yi�� DATE: S- u d..0 --i a, <br /> rD APN: 0 A If-) aLl U APPLICATION M S R009')•C t,3 DEPTH TO FIRST WATER: N Ar Ft h <br /> 7 C <br /> a�j SOILTYPE: <br /> _ S <br /> = REMARKS: <br /> (D '+ r <br /> ar - <br /> O <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUCNRES Q <br /> 73 <br /> 0 <br /> r+ <br /> I rim_ � I <br /> n a � <br /> - I - -- - _ _ , _ - I <br /> I i i ! i l i I i i <br /> SOIL PROFILE IF REQUIRED <br /> Depth Soil T e Depth Soil Type De th Soil Type Depth. Soil T e De th Soil T e <br /> 4 c u�(I <br /> Test Hole#1 Test Hole#2 <br /> Parcel: Diameter: 4 in I Depth:' in Parcel: Diameter: in I Depth: in <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> -1:30 — 1-I <br /> v DRQ-Sw ��erl (D HIL <br /> l0; 5 <br /> 1 o,a(p _31 <br /> 113'.50 5 O-1 <br /> 00 - 3L-1 a1 _ ;t.0 <br /> . 18 A, 4 <br /> l 1 ' a-Oa 1(a <br /> 3.� 0. a <br /> PERCOLATION RATE: D min/i PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: ��T�I Phone: O i'����-0-731 Date 5- IN <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY(REHSI Phone Date S�� 2d T> <br /> EHO 42-03 REV 1112/09 I PERC TEST RATE FORM <br /> .Z7 <br /> (D <br /> n <br /> O <br /> Q <br /> E <br /> N � <br /> m <br /> F O <br /> O O <br /> 0 OD <br /> r. <br /> N <br /> O <br /> m <br /> 00 <br />