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Service Request Form/Report a Concern for Public Works

2. Thank you for filling out our Public Works Service Request Form. Please provide as much information as possible to expedite service. We will make every effort to respond to all work requests in a timely fashion.
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip
13. Phone
14. Email*
16. Service Location (Street Number)
17. Service Location (Street Name)
19. General Location of the Violation or Concern
    Please try to describe the general location of the issue (side of street (north, south, east, west), major intersections (such as 55th and Roe).
21. Type of Service Request*
    (Example: Drainage inlet not working on east side of street, or damaged curb at corner of 49th and Nall)
23. Do you wish to be contact after the Code Enforcement Officer completes the investigation?*

    1. Yes

    1. No
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field