Pool Fill Affidavit

Adjustments to your wastewater charges may apply the first time you fill a pool or after a permitted 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;
  • 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 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 representative will contact you.  


For a residential repair that did not require a building permit, you may choose to submit a request for a wastewater adjustment (INSERT HYPERLINK).  If you choose this option, be aware these types of adjustments are limited to no more than two in a 36-month period.


To ensure proper processing, you must submit your affidavit to JEA no later than 30 days after completion of filling your pool.

Required Fields (*)

Name on Account*

Email Address

Contact Phone Number

JEA Account Number*

Service Address*

New Pool Fill*

Pool Refilled due to Repair*

Pool Capacity (in gallons)*

Date of Pool Fill*


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 or repair (required for new construction and/or any repairs).

Permit Number*

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.