Fillable Form 454 (City of Louisburg)

Fill Online, Printable, Fillable, Blank Form 454 (City of Louisburg) Form

Use Fill to complete blank online CITY OF LOUISBURG (KS) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 454 (City of Louisburg)

On average this form takes 5 minutes to complete

The Form 454 (City of Louisburg) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Louisburg

BROWSE CITY OF LOUISBURG (KS) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Building & Zoning Department
215 S. Broadway, Louisburg, KS 66053
913-837-5371 · louisburgkansas.gov
Backflow Certificate
Inspections are required in accordance with ordinance #959 and the Code of the City of Louisburg. Testing intervals shall
not exceed one (1) year and backflow preventers shall be overhauled as required to keep the device in proper working
order. Backflow preventers are required on commercial buildings and lawn irrigation (sprinklers) where backflow may
occur and where there is a hazard of contamination of potable water supply.
Customer Name: ____________________________________________________________________________________
Service Address: _____________________________________________________________________________________
Customer Phone: ____________________________________________________________________________________
Name of Tester: _____________________________________________________________________________________
Certification Number: ________________________________________________________________________________
Expiration Date: _____________________________________________________________________________________
Company Name: ____________________________________________________________________________________
Company Phone: ____________________________________________________________________________________
Hazard: ____________________________________________________________________________________________
Location of Assembly: ________________________________________________________________________________
Manufacturer: Serial Number: _________________________________________________________________________
Model Number: ________________________________________ Size: ________________________________________
Date of Test: _____________________ Check #1 (psid) ____________________ Check #2 (psid) ____________________
Repairs Made: ______________________________________________________________________________________
Comments: _________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 454 (City of Louisburg)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document