Healdsburg, CA · Sonoma County
Wastewater Discharge Permit Application
Businesses applying for a Healdsburg wastewater discharge permit use this application to describe their facility, operations, and wastewater discharge.
What this form is
The City of Healdsburg uses this application to evaluate and process wastewater discharge permit requests. Applicants must complete every applicable section, provide information about the business, facility operations, pretreatment equipment, and discharge characteristics, and include a facility piping and equipment drawing plus chemical specifications for pretreatment. An authorized company official must sign the certification.
Who needs it
Businesses seeking a Healdsburg wastewater discharge permit should complete this application and provide the required facility information and supporting materials.
How to submit it
Mail or fax the completed application to the City of Healdsburg Municipal Utilities Department/Wastewater, 401 Grove St., Healdsburg, CA 95448-4723. The form lists fax number 707-431-3140.
About notarization
This application is signed and dated without a notary; the company official certifies the information under penalty of law, and the listed drawings and chemical specifications are attachments.
How to submit this form
- 1
Download The Application
Download the Wastewater Discharge Permit Application.
- 2
Complete The Form
Fill in all applicable sections and write N/A where requested information does not apply.
- 3
Gather Required Attachments
Prepare the facility operations and discharge description, piping and pretreatment equipment drawing, and pretreatment chemical specifications.
- 4
Sign And Submit
Have an authorized company official sign and date the certification, then mail or fax the completed application and attachments to the department listed.
Frequently asked questions
- Who uses the Wastewater Discharge Permit Application?
- A business seeking a City of Healdsburg wastewater discharge permit uses this application to provide facility, operational, and discharge information.
- What attachments are required with the application?
- Include a description of facility operations and typical discharge, a drawing of discharge piping and pretreatment equipment, and technical specifications for pretreatment chemicals.
- Do I need a notary for the Wastewater Discharge Permit Application?
- No. The application calls for an authorized company official to sign and date its certification without a notary. The certification is made under penalty of law.
- How do I submit the Wastewater Discharge Permit Application?
- Mail it to the City of Healdsburg Municipal Utilities Department/Wastewater at 401 Grove St., Healdsburg, CA 95448-4723, or fax it to 707-431-3140.
Need something notarized?
This Wastewater Discharge Permit Application doesn’t need a notary — but if you have another Healdsburg form that does, a commissioned online notary can help.