2. .

   

   UPSON COUNTY UTILITIES DEPARTMENT

   Report a Water or Sewage Issue or Violation

4. Reporter's Contact Information
6. First Name
7. Last Name
9. Address
10. P.O. Box/ Apt. Number
12. City
13. State
14. Zip
16. Phone
17. Email
19. Information Regarding Water or Sewage Issue or Violation
21. Establishment/ Business Name, if applicable
23. Location Address (Must include valid address)*
25. Please check all that apply:*

    1. Water Outage
    2. Water Theft
    3. Sewage Issue
    4. Other (Please explain below)
27. Description of Issue or Violation*
29. Photo/File #1 Upload
30. Photo/File #2 Upload
32. Would you like to be contacted regarding this issue?

    1. Yes
    2. No
34. If yes, please be sure to provide your contact information.
36. Would you like an emailed copy?

    1. Receive an email copy of this form.
38. Email Address
40. * indicates a required field
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field