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2. HOA & Location Information

   *Please see 2023 rates*

4. Association *
6. Association Contact Name*
7. Association Contact Number*
9. Association Email Address*
11. Meter Address Location (Max 10)*
13. Additional Address Below
15. 1.
16. 6.
18. 2.
19. 7.
21. 3.
22. 8.
24. 4.
25. 9.
27. 5.
28. 10.
30. Requested Task*

    1. Irrigation Turn ON
    2. Irrigation Turn OFF

    Per the Minnesota Plumbing Code Parts 603.5.23 through 603.5.23.4: The backflow device must be tested upon initial installation and at least annually thereafter. • Test results must be submitted to the administrative authority and to the community public water supplier within 30 days of testing.   RPZ testing results will be REQUIRED to be submitted to Cottage Grove Public Works within 30 days after irrigation turn on.  Failure to comply will result in irrigation turn off and additional fees.

    Please submit results to:

     To:  cgpublicworks@cottagegrovemn.gov

    
    

32. Request Date*
    Request Date

    **Please allow a 5-to-7-day turnaround time due to other requests or events that may arise.

34. Access Code (if applicable)?

36. METER MUST BE PRESENT FOR TURN ON AND TURN OFF

38. Contact Information

40. Name*
42. Irrigation Company*
44. Phone Number*
45. Email Address (Optional)
47. I agree that the above information is correct and that any incomplete or inaccurate information provided may result in denial or delay of request. *

    1. Yes
49. I agree that an RPZ report will be submitted to Public Works within 30 days of irrigation turn on. Failure to do so will result in irrigation shut off and additional fees.*

    1. Yes
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field