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Irrigation Auxiliary Meter Application Online Form

2. Water Conservation Program Application Online Form
   Single Family Home Irrigation System

   Single Family Home Irrigation System

3. Click on the link below to go back to Guidelines
   Residential Irrigation Program

5. Name*

6. Email Address*

8. Service Address*

10. City*

11. State*

12. Zip Code*

14. Contact Phone Number*

15. Other Contact Phone Number

17. Irrigation System Information

19. Is a Rain Sensor installed?*

    1. YES
    2. NO

20. If YES, is the Rain Sensor set to respond to 1/4" of rain?*

    1. YES
    2. NO
22. Is a Backflow Prevention Device installed?*

    1. YES
    2. NO
24. If YES, please provide the following information about the Backflow Prevention Device:

26. Make

27. Model

28. Size

30. Location of Backflow Prevention Device

32. Please provide the Irrigation Controller Information

34. Make

35. Model

36. Date Manufactured

38. Location of Controller

40. Form Submission Understanding & Agreement
    By submitting this form, I agree to the terms and conditions outlined in the Spotsylvania County Water Conservation Policy and the General Installation Guidelines.

    By submitting this form, I agree to the terms and conditions outlined in the Spotsylvania County Water Conservation Policy and the General Installation Guidelines.

42. Authorized Printed Name*

43. Date & Time of Form Submission*
    Date & Time of Form Submission

    Date & Time of Form Submission

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field