Section 1 of 1 in this document

Petition to Remove a Backflow Prevention Assembly

Account Number

Customer's Phone Number

Customer's Email

Are you the property owner?

Yes

Only the property owner is authorized to submit this form.

Reason for backflow prevention removal

Do your outside hose spigots have vacuum breakers installed?

Yes

Don't know

All hose spigots are to have vacuum breakers installed as required by Florida Building Code P2902.4.3

Property Owner's Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Petition will be processed within 30 days of submission.

Petition to Remove a Backflow Prevention Assembly

Customer's Name

Property Address

Are you the property owner?

Do your outside hose spigots have vacuum breakers installed?

Does your property have any of the following? Please check all that apply.

Property Owner's Signature