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Village of Shorewood
Water Safe Cross Connection Survey
This mandatory survey form needs to be completed for each connection to municipal water supply per Illinois EPA regulations.
For more information visit our website at:
https://vil.shorewood.il.us/watersafesurvey.aspx
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* Indicates required question
Water Utility Account Number
*
Please enter the account number as it appears on your water utility billing statement.
Your answer
Customer Name
*
Your answer
Street Number
*
Your answer
Primary Phone
*
Your answer
Primary Email
Your answer
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