LWD Completed Commercial Backflow Permit Application

Lakewood Water District requires that a Cross Connection Questionnaire be completed before a commercial backflow permit application is processed. Please notify the customer that they will need to complete a Cross Connection Survey Questionnaire, please click here to complete the online form.

Permits are required for all new and replacement backflow assemblies. All commercial properties require premise isolation.

Permit cost is $65.00 each for the first two assemblies and $32.50 for each additional assembly. An onsite survey and/or plan review may be required before a commercial backflow permit is issued. If a plan review is required, a $150 plan review fee will be added to the cost of the permit. 

After the permit is issued it will be sent to the customer by email or they can pick up a copy at our main office.

PERMIT REGULATIONS

Visual inspection at the point of connection to potable water is required.

Additional backflow assemblies may be required.

Permit not valid after 6 months.

Enter the address where the backflow assemblies will be installed.
Permit Requested by *
New Installation or Replace Existing? *
New Construction or Remodel? *
Date of Pre-Application meeting if applicable
Irrigation systems employing direct chemical injection will require an RPBA to be installed.
In-Premise assemblies would be used for boilers, steam tables, C02 beverage dispensers, commercial ice makers, commercial dishwashers, water features such as fountains and many other hazards.
Fire Systems employing direct chemical injection will require an RPDA assembly or RPBA assembly to be installed.
All commercial properties require premise isolation at the meter. The number of premise isolation assemblies required should equal the number of domestic water meters.
Customer Paid *
  • Printer-friendly version