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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: CITY: FfZ L A vv% j71 <br />OWNER NAME: 13 iZ t 11 A G --C i,_ -t> I A,) Cr DATE: <br />APN: I el 3 o --12- APPLICATION #: DEPTH TO FIRST WATER: Ft <br />SOIL TYPE: LC AWN <br />REMARKS* <br />LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) <br />..... ... <br />PERCOLATION TEST SKETCH PERMLATtON TEST SKETCH <br />2- DWnfW PVC Pip 2- oiwfttBr M Pix <br />-3 <br />4- <br />,2 <br />.C) <br />LEI, <br />Ljt w2m W" <br />31 ti, (j ;t I LEI RON Loost <br />L <br />SOIL PROFILE (IF REQUIRED) <br />Test Hole # I <br />Parcel: i Diameter: (4 in De the <br />TIME <br />REAojNG <br />WATER DROP <br />REFILLED <br />q:00 <br />i r <br />T <br />.7,14 <br />I2620 <br />. 3 <br />.573 <br />zz <br />t71:36 <br />44. 0 <br />q-4 <br />L4.3 I <br />2-: ;0 <br />1( 32- <br />I) <br />Li Q 1 <br />PERCOLATION RATE: -min/in <br />F IMMENDED SEPTIC <br />TEz>f PERFORMED BY: <br />TEST CERTIFIED BY: <br />OBSERVED BY (RENS): <br />EHD 42-03 REV 1112109 <br />I Test Hole # 2 <br />1 Parcel: Diameter: in 1 Depth: <br />TIME READING WATER DROP REFILLED <br />PERCOLATION RATE: min/in <br />RECOMMENDED SEPTIC AREA: <br />Phone.- (20A)3 b9 -p3 Date -A/ <br />Phone: Zofj 3(e,1-o31S- Date <br />Phone 2xyet - ro r(a -%4' Date 5� <br />PERC TEST RATE FORM <br />