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City of Dunsmuir
Home
News
Government
City Council
Commissions & Committees
Staff
Employment
City weekly reports
Meetings & Agendas
Meetings - List View
Meetings - Calendar View
Meeting Videos
Initiatives
Business Support
Community Resources
Community Promotions Funding
Emergency Preparedness
Firewise
Flood Preparedness
Green Waste Day
Mossbrae Falls Trail
Neighborhood Watch
Short term rental info
Water Conservation
Wildfire Projects
Departments
Airport
Building Department
Code Enforcement
Finance
Fire Department
Planning Department
Parks & Recreation
Public Works
Utility Billing
Wastewater Department
Water Department
Pay Your Bill
water dept
consumer confidence reports
cross connection control program
cross connection control form
cross connection control faq's
cross connection control testers
Water Main Replacement Project
Water Curtailment
Account Number
*
account number as shown on bill
Date
*
MM
DD
YYYY
Name
*
First Name
Last Name
Service Address
*
Mailing address (if different from service address)
Email
*
Phone
*
(###)
###
####
Type of Service
*
Residential
Commercial
Both Residential and Commercial
Do you have a well or other water source?
*
Yes
No
Don't know
If yes to other water source, is it connected to the house plumbing system?
*
Yes
No
Don't know
N/A
Do you have an underground lawn irrigation/sprinkler system?
*
Yes
No
Don't know
If yes to underground system, what is the source?
*
City system
Well
Other
N/A
Do you have a fire sprinkler system?
*
Yes
No
Don't know
Do you have a frost‐proof yard hydrant?
*
Yes
No
Don't know
Do you heat your home with a hot water heating system?
*
Yes
No
Don't know
If yes to above, what is source?
*
Solar
Geo-thermal
Other
N/A
Do you have a swimming pool, hot tub or Jacuzzi tub with a permanent submerged water fill pipe?
*
Yes
No
Don't know
Do your laundry tubs/sinks have an air gap below the faucet?
*
Yes
No
Don't know
Do you have Vacuum Breaker Devices on all of your hose bibs?
*
Yes
No
Don't know
Do you have an existing Backflow Prevention Assembly?
*
Yes
No
Don't know
Cross-Connection Survey submitted!
Thank you for helping keep the best water on earth safe!