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2. Please indicate the nature of your problem by checking the appropriate box(es) below:
4. 1. Pothole
   2. Damaged curb
   3. Traffic signals
   4. Weeds
   5. Dogs barking
   6. Abandoned vehicles
   7. Chemical discharge
   8. Water leaking

   1. Litter
   2. Road striping
   3. ADA complaint
   4. Blocked drainage channel
   5. Street lights
   6. Damaged sidewalk
   7. Traffic/Road signs

   1. Overhanging trees/shrubs
   2. Noise nuisance
   3. Hazardous parking
   4. Storm sewer leaking/blockage
   5. Water leaking on roadway
   6. Loose/protruding manhole cover
   7. Other
6. Brief Description (or other problem not listed)*
8. Location of Problem*
   Enter the address or street intersection of the location of the issue.
9. Image
   Upload an image of the issue if possible.
11. Contact Information
13. First Name*
14. Last Name*
16. Address
18. City
19. State
20. Zip
22. Phone Number
23. Email Address*
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

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