Street Light Maintenance Request

2. Street Light Maintenance Request

4. Name*

5. Email Address

7. Address

9. City

10. State

11. Zip Code

13. Phone Number*

15. NEEDED INFORMATION
    In order for Public Works staff to respond to your concern, you will need to provide the pole number and the nearest street address.

    In order for Public Works staff to respond to your concern, you will need to provide the pole number and the nearest street address.

17. Pole Number*

18. Nearest Street Address*

20. Describe concern

    Be specific: i.e., light is out, light is dim, etc.

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field