2. First Name
3. Last Name*
5. E-mail Address*
6. Phone Number*
8. Address1*
10. City
11. Province
12. Postal Code
14. Is this an emergency?*

    1. YES
    2. NO

    If this concern is an emergency, telephone Utilities Operations at 250.746.2530 or after hours telephone 1.888.453.0148.

15. Which CVRD Sewer or Water System?*
    -- Select One --Arbutus Mtn Estates WaterArbutus Mtn Estates SewerArbutus Ridge WaterArbutus Ridge SewerBald Mountain WaterBald Mountain SewerBrulette Place SewerBurnum WaterCarlton WaterCherry Point WaterCobble Hill SewerCowichan Bay SewerDogwood Ridge WaterDouglas Hill WaterEagle Heights SewerFern Ridge WaterHoneymoon Bay WaterKerry Village WaterKerry Village SewerLambourn Estates WaterLambourn Estates SewerMaple Hills SewerMesachie Lake WaterMesachie Lake SewerMill SpringsSaltair WaterSatellite Park WaterSentinel Ridge SewerShawnigan Lake North WaterShawnigan Beach Estates SewerShellwood WaterTwin Cedars SewerWoodley Range WaterYoubou WaterYoubou Sewer

    Check the Dropdown menu for name of CVRD system.
17. Nature of Water Problem

    1. Low Pressure
    2. High Pressure
    3. Cloudy Water
    4. No Water
    5. Odourous

    1. Water leak
    2. Taste
    3. Discoloured Water
    4. Other
18. Water Service

    1. Shut off (Emergency)?
    2. Shut off (Non-emergency)?
    3. Turn Water on?
20. Nature of Sewer Problem

    1. Sewer Blockage
    2. Overflowing Sewer
    3. Service Locate
    4. Other
22. If other, please explain:
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24. 1. Receive an email copy of this form.
25. Email address

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26. Submit

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