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Hit Counter

This form is for submitting work orders to the Public Works Department for pothole repair.  The priority of the work order will be determined by the Street Department based on severity of the pothole, current workload, and safety factors.  This form will not work with Netscape. If you have any questions about this form or any problems please email the Webmaster
 
Name
Address
Daytime Phone
Email Address

Location of the Pothole

Nearest street address

 

Answering the following questions will help process your request more quickly:

 

What type of surface is the street?

Asphalt

Concrete

Unimproved

Don't Know


 

Is the pavement washed out or pushed up on the sides?

Washed Out

Pushed Up

Don't Know


 

Is this pothole near a bus stop?

Yes

No

Don't Know


 

What is the exact location of the pothole?

End of driveway

Intersection

Shoulder

Street


 

Is there water in the pothole?

Yes

No

Don't Know

 

Comments:

 

 

Please type the letters and numbers you see in the below graphic into the space

provided and then click on the submit button.  This is to prevent form spam.  Thanks