Purpose: Use this form to report a problem to be repaired or street maintenance that needs to be performed.

Name:*

Email:*

Contact Phone Number:

Issue Needing To Be Serviced*

Pothole Sidewalk

Tree Trimming Special Trash Pick-up

Size of pothole:

Small (less than 12 inches across) Medium (12-24 inches)

Large (over 24 inches)

Location of issue (Street Name)*

Additional Notes/Comments: