Please fill in ALL items from 0 through 13.
Copies: two ORIGINAL copies of this form, two copies of all plans, engineering reports and supporting materials must be submitted.
Entries: no missing or incorrect entries for any field.
Printing: print or type ALL except signatures (no photocopies or electronic images are acceptable).
Design engineer or architect: original ink signature and seal required on both copies.
Owner address: failure to provide correct property owner/customer mailing address will result in delayed notification.
Pressure and cost: no blank is permitted; use fair market value if work is free of charge.
| Question | Answer |
|---|---|
| Form Name | GEN236 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 50 |
| Avg. time to fill out | 9 min |
| Edition | 1/2019 |
| Issuing agency | Department of Environmental Protection, Bureau of Water and Sewer Operations |
| Where to send | Two original copies of this form, two copies of all plans, engineering reports and supporting materials, to New York City, Department of Environmental Protection, Bureau of Water & Sewer Operations, Cross-Connection Control Unit, 3rd Floor Low-Rise, 59-17 Junction Boulevard, Flushing, NY 11373 |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | GEN236, GEN 236, Form GEN236, Form 236, NYC DEP GEN236, Application for Approval of Backflow Prevention Assemblies |
| Official source | GEN236 (Rev 1/2019), New York City Department of Environmental Protection |
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