Residential Backflow Permit Application

Please complete the application for a residential backflow permit.

Permits are required for all new and replacement backflow assemblies.

District staff will evaluate the application and contact you with a total cost for your backflow permit, and arrange to take payment for the permit. Permit cost is $65.00 each for the first two assemblies and $32.50 for each additional assembly.

After the permit is issued it will be sent to you by email or you 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.

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Property Address *

Enter the address where the backflow assemblies will be installed.

Property Owner Name *

Property Owners Address (if different than property address)

Permit Requested by *

Owner

Property Management

Contractor

Other

Phone Number *

Email Address *

New Installation or Replace Existing?

New Assemblies

Replace Existing

Number of Irrigation Assemblies

Irrigation systems employing direct chemical injection will require an RPBA to be installed.

Number of In-Premise Assemblies

In-Premise assemblies would be used for boilers, spas, pools, water features such as fountains or ponds.

Number of Fire System Assemblies

Fire Systems employing direct chemical injection will require an RPDA assembly or RPBA assembly to be installed.

Number of Premise Isolation Assemblies

Residential Backflow Permit Application

Contact Information