Complete Form 62-604.300(3)(b) 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 or delegated local program.

 

Form Number: 
62-604.300(3)(b)
Effective-Revision Date: 
Monday, October 4, 2021
Last Modified: Thursday, Sep 17, 2026 - 11:47am