First Name
Last Name
Address
City
State
::
Zip Code
Phone
Cell
Email
Location/address where service is needed
Same address as above
Address
City
State
::
Zip Code
TYPE OF SERVICE
Street light maintenance
Culvert installation
Tall grass complaint
Gas complaint/question
Ditches cleaned
Water complaint/question
Permit request/question
Junked vehicle
Sewer complaint/question
Trash complaint/question
Other (explain below)
Brief Comments
Call 896-8481 to report broken lines or other issues that need immediate attention.