City of Apple Valley Residential & Commercial Backflow Permit Application
7100 147th Street W, Apple Valley MN 55124
952-953-2588
ALL INFORMATION IS REQUIRED
SITE ADDRESS___________________________________________________________________________________
OWNER__________________________________________________________________PHONE____________________
ADDRESS________________________________________ CITY_________________ STATE_______ ZIP____________
CONTRACTOR________________________________________________________ PHONE ________________________
EMAIL ADDRESS (REQUIRED)______________________________________________________________
ADDRESS________________________________________ CITY__________________ STATE ______ ZIP ___________
LICENSE #_____________________ CONTACT NAME ___________________________PHONE_____________________
Applicant is:
____________Property Owner
____________Contractor
______________________________________________________________
___________________________________
Signature of Applicant
Date
Applicant may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an Email Update on the City’s
website at www.cityofapplevalley.org.
Describe the type (RPZ/PVB etc), model, location and purpose:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
All backflow prevention devices shall only be installed by a licensed plumber or the resident homeowner.
Sprinkler systems installed within the right-of-way shall be maintained and/or repaired by the sprinkler system
owner. This includes, but is not limited to, repairs necessary because of damage caused by city snow-plowing
operations.
A method for draining the system should be provided on the sprinkler system side of the backflow prevention
device.
A water permit is also required and a water inspection is required when a plumber cuts into a water main or any
pipe on the street side of the water meter. Contact the engineering department for more details.
A permit is issued on the condition that all work shall be done in accordance with the Apple Valley City Code. Permits remain active
for 6 months.
____________________________________________________________________________________________________
For Office Use Only
Permit fee $
63.00
Date Paid ___________________
Surcharge $
1.00
Check #___________________
Total $ _____64.00________
Permit #__________________
City of Apple Valley Commercial and Residential Backflow Preventer Permit for 2017