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SR0083415_SSNL ADDENDUM
Environmental Health - Public
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SR0083415_SSNL ADDENDUM
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Last modified
2/24/2022 1:21:10 PM
Creation date
2/23/2022 5:06:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL ADDENDUM
RECORD_ID
SR0083415
PE
2602
FACILITY_NAME
88 MARKET & GRILL
STREET_NUMBER
21850
Direction
E
STREET_NAME
LIBERTY
STREET_TYPE
RD
City
CLEMENTS
Zip
95227
APN
02120024
ENTERED_DATE
3/16/2021 12:00:00 AM
SITE_LOCATION
21850 E LIBERTY RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
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EHD - Public
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gu��r SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: -' � a�L CITY. <br /> OWNERNAME: �n�+S1rr S ! DATE: <br /> APN: a f` J J~d f �-� APPLICATION#: 7 0� DEPTH TO FIRST WATER: �V�tV Ft <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES{SHOW WELLS AND STRUCTURES) <br /> FP, FPFT�: FH F <br /> � - <br /> -�l <br /> H, H <br /> P <br /> r Fri _n FrT Fn Fr] Fj <br /> SOIL PROFILE IF REQUIRED) <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> Test Hole # 1 Test Hole #2 <br /> Parcel: I Diameter: Ll in I Depth: � in Parcel: Diameter: H in I Depth: yL in <br /> TIME READING WATER DROP REFILLED ^TIME READING WATER DROP REFILLED <br /> y1",67 11: 12. L 2 <br /> o <br /> Y2 yU� , O 1 . 0 .O a <br /> 1 •v N'0 <br /> 0`1 5;,'15 ,7� o <br /> 1''31 5- 0.r75 o <br /> 'rb1 S a.-7 �— <br /> PERCOLATION RATE: D min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC,,AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: pall Phone: Date <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY(REHS): Phone` C�1ln^' 4; Date S <br /> EHD 42-03 REV 11/2/09 PERC TEST RATE FORM <br />
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