Skip to Main Content
Do Not Show Again
How Do I...
Select a Category
Access East Peoria Service Request
Application For Employment
Buildings and Inspections
City Clerk's Office
East Peoria's Clean Sweep
Kudos! Compliment Form
Paul Peterson Bright Spot Award
War Memorial Veterans Street Naming Program
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Cross-Connection Control Survey
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Notice to Water Customers
View Notice to Water Customers
Before submitting this form, make sure you've reviewed our notice regarding the Cross-Connection Control Survey.
Name (Or Name of Business)
Please check whether or not you have the following:
Lawn Irrigation System
Fire Sprinkler System
Boiler for Heat (Not Water Heater)
Is there an alternate water source (i.e. well, pond) at your location which is connected to City water?
Does your business use any type of equipment with chemicals that is connected to City water?
Do you have any equipment other than household appliances using water?
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow