Complete Form 62-604.300(3)(a) by clicking on the document (pdf) above.

Please review the Electronic Submission Instructions and Domestic Wastewater Permit Application Fees documents prior to submitting a form electronically.
Please email the completed form to the appropriate DEP District Office’s email address
Note, if your facility is regulated by a delegated local program and you want to submit the form electronically, please contact your delegated local program.

Form Number: 
62-604.300(3)(a)
Effective-Revision Date: 
Monday, October 4, 2021
Last Modified: Tuesday, Nov 19, 2024 - 10:45am