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Cross-Connection Control Residential

  1. Are you the property owner?

  2. Alternate Water Source*

  3. If yes, please indicate which source you have

  4. Boiler or Steam Heat*

  5. If yes, please indicate boiler type

  6. Fire Sprinkler Protection System*

  7. Lawn Irrigation System*

  8. Shampoo Bowl/Sink*

  9. Swimming Pool/Hot Tub*

  10. Other Equipment with a Direct Connection to City Water*

  11. Do you have backflow preventers on your property?*

    Backflow Preventer

  12. Pictures of devices in question can be e-mailed for review by the City’s Plumbing Inspector. The City’s Plumbing Inspector can also be contacted via phone at 309.524.2374.

  13. Leave This Blank:

  14. This field is not part of the form submission.