Cross Connection Control Plan Check Application

"*" indicates required fields

APPLICATION PACKAGE REQUIREMENTS FOR PLAN APPROVAL

Prior to plan approval, the District must have the following items executed by the Developer:

$434 Plan Check/Inspection Fee made payable to Rowland Water District. (Fee applies to the plan check and inspection for one backflow assembly).

1 (ONE) CD or flash drive of the first submittal PDF or 2 (TWO) 24 x 36 first submittal drawings needs to be submitted.

*Assembly type and location requires approval by Rowland Water District Prior to Installation

APPLICANT INFORMATION

Company Name *

Contact Name *

Company Address *

Street Address City State / Province / Region ZIP / Postal Code

Phone *

Cell Phone *

Email *

PROJECT INFORMATION

Project Name *

Project Address *

Street Address City State / Province / Region ZIP / Postal Code

New Construction or Upgrade *

Site Water Use Type (Commercial, Fire System, Manufacturing) *

I, the [applicant] for this Cross Connection Control Plan Check Application, warrant the truthfulness of the information provided in this application. I understand that typing the name constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Signature of Applicant *

Date

FOR DISTRICT USE ONLY

Check Issued By:

Date

Number of Backflow Assemblies:

RWD Customer Rep:

Submittal Fee Paid

File *

Max. file size: 200 MB.