Skip to content
Jefferson County Public Utility District
Outage Map
1-360-385-5800
Email
Outages
Search
Search
1-360-385-5800
Email
Outage Map
My PUD
Customer Service
Service Applications
Payment Assistance
Online Bill Pay
Rainy Day Donations
Meter Opt-Out
Close
Electric
Rates/Specifications
Report An Outage
Trees and Streetlights
Emergency Prep
Safety Near Electricity
Infrastructure/Metering
Close
Water/Sewer
Rates/Specifications
Water System Planning
Water Quality & Safety
Annual Quality Reports
Water Saving Tips
Sewer and Septic
Close
Sustainability
Clean Electricity
Efficiency Rebates
Solar/ Net Metering
Energy Saving Tips
GO PAPERLESS!
Close
Broadband
Fiber Sign-Up
Project Map
FAQs
List of Local ISPs
PUD WiFi Hotspots
Close
About Us
Mission & History
Commissioners
Management & Staff
Job Opportunities
Recent News
Event Calendar
Close
Records/Data
Meeting Archives
BOC Resolutions
Financials & Budgets
Policies & Agreements
Plans, Projects, Studies
Small Works Roster
Public Records Request
Close
Search
Search
Water Use Questionnaire
RESIDENTIAL CUSTOMERS
The purpose of this questionnaire is to help determine if you have any special plumbing or activities that may pose an increased risk of contamination to the water distribution system. Please respond by checking the appropriate box below:
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Plumbing or Activity Present on Premises
Underground Sprinkler System
(Required)
Yes
No
Water Treatment System
(Required)
(e.g. Water Softener)
Yes
No
Solar Heating System
(Required)
Yes
No
Residential Fire Sprinkler System
(Required)
Yes
No
Other Water Supply
(Required)
(Whether or not connected to plumbing system.)
Yes
No
Sewage Pumping Facilities or Grey Water System
(Required)
Yes
No
Boat Moorage with Water Supply
(Required)
Yes
No
Hobby Farms or Animal Watering Troughs
(Required)
Yes
No
Swimming Pool or Spa
(Required)
Yes
No
Greenhouse or Decorative Pond
(Required)
Yes
No
Photo Lab or Dark Room
(Required)
Yes
No
Home-Based Business
(Required)
Yes
No
Explain Home-Based Business:
(Required)
Please return the completed questionnaire along with your completed application for service.
If you have checked "Yes" to any of the above, we will contact you to request further information. Your cooperation in completing this questionnaire is most appreciated.
If you have any questions, please contact the PUD at (360) 385-5800.
Signature
Date
Month
Day
Year
CAPTCHA
Please ensure Javascript is enabled for purposes of
website accessibility