Get 4092a Application For Operation

The 4092A Application For Operation is a crucial document for individuals and organizations managing limited use public water systems. This guide provides comprehensive instructions on how to accurately fill out the form online, ensuring compliance with established health regulations.

Follow the steps to complete your application accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the appropriate application type by checking one of the options: Initial Operation, Renewal, or Change of Owner. Ensure you understand the implications of your selection.
3. Fill out the Water System Site Information, including the permit number, water system name, and physical address. Provide details about the residential or non-residential nature of the site, including the number of residences, residents, service connections, and operational details.
4. Enter the Water System Owner Information. If the details are the same as the previous application, verify the phone numbers. Provide the owner's name, email address, mailing address, and phone numbers.
5. If the Water System Operator is different from the owner, complete the Water System Operator Information section with the operator's name and contact number.
6. Complete the On-site Contact Person or Major Tenant Information if applicable. Provide their name(s), location, and phone number.
7. Read and agree to the operational agreement paragraph. Acknowledge the importance of accurate representation of information and adhere to sanitary standards.
8. Indicate any attachments included with the application based on your situation (new system, existing system, annual renewal, or change of owner). Make sure to provide any required documentation as listed.
9. Identify the authorized applicant. Print and sign your name in the spaces provided, along with the date of submission.
10. Once all fields are completed accurately, you can save changes, download the form, print it, or share it as required.

Complete your 4092A Application For Operation online today to ensure timely processing and compliance.