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2. First Name*
3. Last Name*
5. Email Address*
6. Phone Number*
8. Address
10. City
11. State
12. Zip Code
14. Please indicate the nature of your problem by checking the appropriate box(es) below:
16. Streets, Electric, Water, Sewer and Parks (check all that apply to the issue)

    1. Blocked Drainage Channel
    2. Chemical Discharge
    3. City Park Issue
    4. Damaged Curb
    5. Damaged Sidewalk
    6. Downtown Parking Structure
    7. Litter

    1. Loose/Protruding Manhole Cover
    2. Overhanging Trees/Shrubs
    3. Pothole
    4. Power Outage
    5. Road Striping
    6. Street Lights
    7. Storm Sewer Leaking/Blockage

    1. Traffic Signals
    2. Traffic/Road Signs
    3. Trees Near Powerlines
    4. Water Leaking
    5. Water Leaking on Roadway
    6. Work Without a Permit
18. Code & Parking Enforcement: (check all that apply to this issue)

    1. Abandoned/Inoperable Vehicles
    2. Animals
    3. Demand Request
    4. Fences
    5. Graffiti

    1. Illegal Construction/No Work Permit
    2. Junk, Debris, Outside Storage Accumulation
    3. Noise Nuisance
    4. Nuisance/Complaints
    5. Overgrown Vegetation

    1. Parking
    2. Pools - Green/Unattended
    3. Sign Violations
    4. Unlicensed Business
    5. Weed Abatement
20. General Complaints / Issues

    1. ADA Complaint

    1. Discrimination Complaint

    1. Fair Housing Complaint
22. Brief Description (or other problem not listed)*
24. Location of Problem*
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit

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