Complete Form 62-640.210(2)(d) 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.
To submit this 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.
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