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2. Request Information
   Please enter the following information about your service request:
   
   Select a problem from the drop down list.
   
   Enter the description of the problem or service request in detail in the box.
   
   Enter the address / location of the problem or service request. If the service / problem has a street address, enter it. If the service / problem is at an intersection, enter the names of the cross streets in the box and specify exact location (i.e., northeast corner) at the intersection. If you are reporting a street light out, be sure to enter the number located on the tag on the pole itself along with the address / intersection of the street light.
4. Type of Service or Problem
6. Type of Service or Problem *
   -- Select One --Activity / Use Not Permitted in Zoning DistrictAnimal Cruelty or NeglectAnimal Live Trap (Humane) RequestAnimal with InjuriesBackflow QuestionBarking Dogs ComplaintBridge: Remove DebrisBrush Needs TrimmingBuilding Activity Without PermitBusiness Inappropriate for Residential Zoning DistrictCart Left at Curbside Over 24 HoursCity Vehicle Reckless Driving / Unofficial UseCurb & Gutter Repair NeededDead Animal on Street / Road / ParkDebris in Right of WayDitch / Drainage / Storm Sewer CleaningDriveway Culvert: CloggedDumping IllegallyElectrical Connection - SubstandardFire Escape Planning & Public EducationFire Hydrant / Wet / Standing or Leaking WaterFire Hydrant DamagedFire Inspection Request - Home or BusinessFlood Plain - FEMA QuestionsGarage / Yard Sale is Ongoing ReportGas Connection - SubstandardGraffitiGrass / Weeds on Occupied LotGrass / Weeds on Vacant LotGravel Street MaintenanceGuardrail Repair / InstallationMowing in Right of Way NeededParks Restroom Maintenance NeededParks Vandalism ReportParks Water Leak ReportPlayground Equipment ConcernPotholePublic Health Hazard-Standing WaterPublic Health Hazard - Unsafe Plumbing ConditionsPumping Station Alarm SoundingSales Tax / HMR Tax / Business Regulation ViolationsSeback of Structure Violation ReportSewer Coming Out of GroundSewer Manhole Lid MissingSewer Manhole OverflowingSewer Overflow Into Creek or Drainage DitchSewer Problem - MiscellaneousSidewalk Repair NeededSign Violations (Yard Sale / Political, Etc.)Smoke Detector RequestSnow & Ice Removal from StreetsStorm Drain BlockedStreet FloodingStreet Light Out (Tell Us the Pole Number & Address)Street Sweeping NeededSubstandard Unoccupied Structure ReportToo Many Unrelated Persons Living in a Dwelling ReportTraffic Sign - New RequestTraffic Sign Down / Vandalized / MissingTraffic Signal MalfunctionTraffic Signal Request Study for New SignalTrail Light OutTrail / Path Maintenance NeededTrash / Junk / Litter Violations - Private PropertyTrash or Garbage - Dumpster AreaTrashy Construction SiteTree - Need RemovalTree Limbs - Need RemovalTree Preservation ViolationUnsecure StructureW&S Unsafe ConditionsWater Main LinkWater Meter Box Lid Needs ReplacingWater Pressure Low / No Water PressureWater Problem - MiscellaneousWater Problem - Taste / OdorWildlife Problem Report
8. Address of Problem*
10. Address2
12. City
13. State
14. Zip
16. Proximity
    -- Select One --AlleyBlock FrontIntersectionRearNorthSouthWestEast
18. Locator Information
    If there is no street address for the service / problem, please describe the location here as clearly as possible, including cross streets, landmarks, other references, and for street lights, the pole number, when available.
22. Requestor Information
    Please enter the following information:
    
    Enter your first and last name.
    
    Enter your contact information.
    
    You must enter your mailing address, or you must enter your telephone number, or you must enter your email address, or your email address is required and the box below must be checked if you wish to receive an email both when we get your request and when your request is completed. Your email address alone will get a confirmation email from us.
24. First Name*
25. Last Name*
27. Address1
29. Address2
31. City
32. State
33. Zip
35. Daytime Phone
36. Evening Phone
38. Email Address
40. Contact Me

    1. Please contact me at this email address regarding the progress of this request.
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