What is the OWTS Application Supplemental Form A?

It is an owner-builder acknowledgment and verification form for a Merced County onsite wastewater treatment system permit application listing the property owner as builder.

Who must complete this form?

The property owner named as the builder on the permit application must read and initial the statements, complete the declarations, sign, and return the form.

Do I need a notary for the OWTS owner-builder form?

No. A notary is not required. The form says the agency may verify the owner’s signature by driver’s license, notarization, or another acceptable method; some declarations are made under penalty of perjury.

How do I submit the OWTS owner-builder form?

Return it to the Merced County Division of Environmental Health at 2222 “M” Street, Merced, CA 95340.

Merced County, CA · Merced County

No notary required

OWTS Application Supplemental Form A – Owner-Builder

Merced County property owners complete this supplemental form to acknowledge owner-builder responsibilities for an onsite wastewater treatment system permit.

At a glance

Issued by: City of Merced County · Merced County, Merced County, California
Notarization: Not required: file this form without a notary.
Official source: countyofmerced.com
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

Merced County requires this form when an onsite wastewater treatment system permit application names the property owner as the builder. The owner reads and initials responsibility statements, identifies the project location and parcel number, completes the owner-builder declaration, and signs; construction lending details are included if applicable.

Who needs it

Property owners named as builders on an onsite wastewater treatment system permit application must complete and return this form before the permit can be issued.

How to submit it

Return the completed form to the Merced County Division of Environmental Health, 2222 “M” Street, Merced, CA 95340.

About notarization

This document is signed without a required notary; it says the owner’s signature may be verified by driver’s license, notarization, or another method acceptable to the agency, and includes declarations under penalty of perjury.

How to submit this form

1
Download the Form
Download the OWTS Application Supplemental Form A – Owner-Builder.
2
Complete the Owner Acknowledgment
Enter project details, read and initial each statement, and complete the owner-builder declaration.
3
Complete Applicable Details
If applicable, provide construction lending agency information; sign and date the required sections.
4
Submit to the County
Return the completed form to the Merced County Division of Environmental Health, 2222 “M” Street, Merced, CA 95340.

Frequently asked questions

What is the OWTS Application Supplemental Form A?: It is an owner-builder acknowledgment and verification form for a Merced County onsite wastewater treatment system permit application listing the property owner as builder.
Who must complete this form?: The property owner named as the builder on the permit application must read and initial the statements, complete the declarations, sign, and return the form.
Do I need a notary for the OWTS owner-builder form?: No. A notary is not required. The form says the agency may verify the owner’s signature by driver’s license, notarization, or another acceptable method; some declarations are made under penalty of perjury.
How do I submit the OWTS owner-builder form?: Return it to the Merced County Division of Environmental Health at 2222 “M” Street, Merced, CA 95340.

Need something notarized?

This OWTS Application Supplemental Form A – Owner-Builder doesn’t need a notary, but if you have another Merced County form that does, a commissioned online notary can help.