Location of Street Light

• *Street Light Pole Number: (Pole number is located 6 to 10 feet up from bottom of the pole; best method to identify pole needing repair.)

  or

  *Closest Street Address Near the Pole: (example: 4756 W. Polinta St.)

• Additional Information Regarding this Repair Request:

  No Light - Burned Out
  Light Always On - Even in Day
  Pole Knocked Down
  Rust Damage
  Exposed Electric Wires
  Series of Lights Without Power
  Leaning Pole
  Bent Pole
  Bent or Loose Arm
  Light/Glass Broken Out
  Light Flickers On and Off
  Shield Missing (Not all lights have shields)
  Other
  
• In the event we need to follow-up with you, please fill in as much of the following information as possible.
• *Your Name
• *Daytime Phone (Use 10-digit phone number)
• If you would like to receive an e-mail notifying you of the repair status, please provide your e-mail address:
  E-mail Address
• 
  
• Before you submit this e-mail form, we would like you to be aware of the city's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.

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