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Wastewater Facility or Activity Permit Application-General Information-Form 1


Complete Form 62-620.910(1) by clicking on the document (pdf) below.  

Please review the Electronic Submission Instructions and Domestic Wastewater Permit Application Fees documents prior to submitting a form electronically.

Form 62-620.910(1) should not be submitted electronically by facilities permitted to discharge to surface waters [i.e., facilities that are permitted under the National Pollutant Discharge Elimination System (NPDES) program and have a permit number beginning with “FL0”]. For NPDES facilities, mail the completed form along with all required attachments and fees to the appropriate DEP District Office. Applications for revisions to NPDES permitted facilities which do not affect the surface water discharge may submit Form 62- 620.910(1) electronically. If you have questions regarding the method of submittal, please contact the appropriate DEP District Office.

If your facility does not discharge to surface waters (non-NPDES) and you would like to submit the 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: 
Effective-Revision Date: 
Friday, July 30, 2010
Last Modified:
June 30, 2023 - 10:31am

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