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2. Get involved, tell us what you think!
   The city encourages public comment and participation, and invites you to become involved by filling out the following informational survey. Please take a few minutes to provide us your important feedback.
4. Are you a resident of the City of Bremerton?

   1. Yes
   2. No
6. Do you own a business in the City of Bremerton?

   1. Yes
   2. No
8. Do you own or rent a home in the City of Bremerton?

   1. Own
   2. Rent
   3. Neither
10. How man years have you lived in and/or owned a business in Bremerton?
12. What are your main sources of information regarding environmental issues?

    1. Radio
    2. Television
    3. Bill inserts
    4. Signage / Billboards

    1. Newspapers
    2. Internet
    3. Other
14. Other
16. Have you seen or received information from the City of Bremerton on water issues?

    1. Yes
    2. No
18. If yes, please check all that apply:

    1. Inserts or messages in my utility bill
    2. City website
    3. Brochures picked up at a public place
    4. Displays

    1. Programs on public access television
    2. One-on-one discussions with a utility employee
    3. Other
20. Other
22. Did you find this information helpful?

    1. Yes
    2. No
24. What activities, if any, do you feel contribute to water pollution in your neighborhood?

    1. Fertilizing lawns
    2. Poor septic system maintenance
    3. Water runoff from streets
    4. Pesticides

    1. Construction
    2. Illegal dumping
    3. Domestic pets
    4. Other
26. Other
28. I protect water quality and ensure clean runoff through the following activities:

    1. Taking my car to a car wash that recycles
    2. Using a broom instead of a hose to clean my walkways
    3. Using slow-release organic fertilizer
    4. Not using chemical pesticides in my landscape

    1. Disposing of household hazardous waste at the county facility
    2. Cleaning up my pet waste in my yard or when I walk the dog
    3. Maintaining my car so that it doesn't leak oil other automotive fluids
    4. Other
30. Other
32. I have the following comments or suggestions on the City of Bremerton's Stormwater Management Program:
34. First Name
35. Last Name
37. If you would like a response to your comments or questions, please supply your email address below.:
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

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