DAWSON COUNTY SEWAGE DISPOSAL SYSTEM PERMIT
NAME______ ___________
ADDRESS___ _____ PHONE___________
I hereby submit an application to ( ) construct; ( ) alter an individual sewage disposal system. The system will be located in Dawson County:
Number of bedrooms _____ _____________ Basement: yes ( ) no ( )
Basement floor drains: yes ( ) no ( )___ Automatic washer: yes ( ) no ( )
Garbage grinder: yes ( ) no ( )
Construction material ( )
Concrete ( ) Fiber Glass ( ) Steel
( ) Polyethylene
If steel tank, is it approved by Underwriters Lab? yes ( ) no ( )
Liquid capacity of tank _________ ______ gallons.
The results of the percolation test are __________ minutes absorbed per inch for the drainfield site.
According to the Dawson County Soil Survey Manual, the soil permeability is __ _ inches per hour and the soil classification at the drainfield site is ___________ ____________ .
MINIMUM
INSTALLATION DESIGN - (Linear or square feet of drainfield)
___________
___________
___________
Are you installing the sewage disposal system yourself? yes ( ) no ( )
If not, who will be doing the work? Name________
Address_______ ________ Phone____________
I assume the responsibility
of notifying the Dawson County Sanitarian a minimum of 24 hours in advance when
the above sewer system is ready for the final inspection. Covering the system without final inspection
is illegal.
Applicant_____
Date Issued____ __ Date
Inspected____________
Approved ( ) Denied ( ) Authorized Signature_____
FEE PAID_____ ___ COMPUTER_____________ _ OWNER COPY SENT_________ ___ PERMIT NO.____________
File: forms\sspermit