Section 1 of 1 in this document
Residential Meter Request
Builder Company Name
*
Email
*
Phone Number
*
Full Address
Street Address
*
City
*
State
*
Zip
*
# of Units
*
Subdivision
*
Phase #
*
Lot #
*
Permit #
*
Type of Service
Potable
Reclaimed
Backflow Prevention Assembly
Make
*
Model
*
Size
*
Type
RP
DC
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
Sign Here
First Name
Last Name
Email
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.
disregard this