WATER USE QUESTIONNAIRE

Name*

First Last

Surfside Address*

Please enter the Surfside address for which you are filling out this form.

Street Address Address Line 2 City State ZIP Code

Division

Block

Lot

Telephone No*

Email Address

Please check any item that may apply.

If this is new construction please answer based on proposed or planned use.

Check boxes left

Irrigation or sprinkler system (not above ground hoses and sprinklers)
Fire protection sprinkler system
Yard hydrants (frost proof)

Check box jacuzzi

Jacuzzi, hot tub, spa, swimming pool

Jacuzzi sub-checks

indoor
outdoor
filled with hose
plumbed in

Sink Types

Laundry sink, utility sink, mop sink, fish or clam sink

Sink-type-sub-checks

sink faucet has threads that fit garden hose

Pond or fountain

Pond or fountain

pond-or-foundation-sub-checks

filled with hose
plumbed in

Water filter or water softener equipment

Water filter or water softener equipment

water-filter-sub-checks

under kitchen/bathroom sink
whole house system
other

RV hook up

RV hook up

number of connections:*

Checkbox set

Please provide a brief description of any other item connected to the water system on your property:

If you have a cross connection control device please provide the location on property:

Comments or Questions:

Signature*

Name

First Last

Date

Consent*

I certify that the above information is true, correct, and complete to the best of my knowledge.*

Surfside Homeowners Association