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Welcome to the Village of Antioch, IL, Action Line
Today is Thursday, August 11, 2022.
Backflow Device Survey

Notice to Property Owners with Backflow Devices
IEPA Title 35 Section 653.801 requires all property owners with backflow devices to complete a survey. To complete the survey, please answer the questions below, or contact the Public Works Department at 847-395-1881 if you have any questions.

* Information is required.

Contact Information

* First Name:
* Last Name:
Business Name:
Email:
Daytime Phone: (
* Address:
* City:
* State:
* ZIP:

* Do you currently have any of the following at the above mentioned address? (check all that apply)





6
 
If other, please specify:
 
* Backflow Assembly Manufacturer:
 
* Backflow Assembly Model:
 
* Backflow assembly Serial #:
 
* Size:
 
* I affirm the information above to be accurate to the best of my knowledge.

 
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Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

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