Manatee County Utilities

Residential Meter Request

Builder Company Name

Phone Number

# of Units

Subdivision

Phase #

Lot #

Permit #

Type of Service

Potable

Reclaimed

Backflow Prevention Assembly

Make

Model

Size

Type

N/A

Serial Number

Location (Left of Drive, NW CRN, etc.)

Tester Company Name

Date Tested

Please confirm that the Assembly is installed in accordance with Manatee County Standards

Concrete Pad Formed to Code

Risers are copper or brass and properly sleeved

Pressure Relief Valve on Downstream side

Height of assembly is between 12” – 18”

Sign Here

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.