Pool Fill Affidavit

Adjustments to your wastewater charges may apply the first time you fill a new pool or after a repair. To determine if your charges may be adjusted, complete and submit the form below. You will need the following information:

• JEA Account Number;
• Capacity of pool (in gallons) as noted on the permit issued by the Building and Zoning Department;
• Date the pool was filled;
• Active Permit Number (required for new pool);
• Name of Builder/Contractor/Person completing the repair; and,
• State Certification or Registration Number of Builder/Contractor.

Upon receipt of your request, JEA will review the documentation, confirm the permit was issued by the Building and Zoning Department, if applicable, and verify the repair was related to the structure of the pool or pool equipment. JEA will also assess the meter readings prior to and after the pool was filled. If additional information is needed, a JEA representative will contact you. 

To ensure proper processing, you must submit your affidavit to JEA no later than 30 days after completion of filling your pool. If approved, you may only receive one in any 12-month period.  

*Name on Account: *Email: *Phone: *JEA Account Number: *Service Address: *City:

*State: (Select One) Florida Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

*Zip Code: *New Pool Fill:
Yes
No
  Permit Number (An Active Permit is required for a new pool.):

To ensure the proper processing of your request, include the permit number, which was issued by the Building Inspection Division and active at the time of the construction (required for new construction).

*Pool Refilled due to Repair:
Yes
No
  *Pool Capacity (in gallons):   *Date of Pool Fill: *Name of Builder/Contractor/Person completing the Repair:   Builder/Contractor State Certification or Registration Number:   By checking this box, I certify that the information provided is true and correct. I have accurately stated the pool’s capacity and building permit number as issued by the Building Inspection Division. My signature also authorizes JEA to process an adjustment, on the account indicated above, for the wastewater charge up to the quantity of water used to fill the pool.   I understand that for JEA to consider my request, this affidavit must be submitted within 30 days of the completion of the pool fill.