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Manatee County Utilities
Section 1 of 1 in this document
Temporary Backflow Device 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
Please confirm the following:
Lot is clearly marked with a lot number or building permit is posted
Meter box and lid are visible and accessible
Meter resetter inside box is not bent or altered
Meter service has water
Requester's Signature
First Name
Last Name
Email
Choose how to sign
Draw
Type
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