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2. Identify your concern*

   Please choose the category that is most closely associated with the issue:

   1. Obstruction of the Right-of-Way (Basketball goals, signs, etc.)
   2. Illegal Dumping & Litter
   3. Junk Vehicles
   4. High Grass and Weeds
   5. Substandard building or dilapidated structure
   6. Pothole
   7. Drainage
   8. Street Condition
   9. Water Leak
   10. Police

   1. Fire
   2. Parks
   3. City Buildings and Facilities
   4. Stray Animal
   5. Street Light Outage
   6. Traffic Signal Outage
   7. Street Sign
   8. Customer Service
   9. Other
4. Your Contact Information
6. First Name
7. Last Name
9. Phone Number
10. Email Address
12. Street Address
14. Exact Location of Job Requested (if known)
16. Street Name or Address*
18. Nearest Two Cross Streets
20. Description of Concern*
22. Picture (Optional)
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field