Street Repair Request

Use this form to notify the City of a pothole or other street failure.

A street failure includes anything that impairs the normal flow of traffic, such as loose manhole covers, debris in the street or flooding.

• Please submit a separate form for each request.
• Provide as much information as possible about the location of the pothole or street failure.
• Avoid vague descriptions like "One mile west of Carlisle" or "3 lights south of Lomas".
• When listing cross streets, please be exact (i.e., if the street failure is in a residential area, list residential streets as the cross streets, not the closest major intersection).

If you have difficulties with the form, please call 311.

Street Failure Information

Date Observed (Required)

-- 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Type of Street Failure

Choose One

Pothole Curb or Gutter Damage Crack in Street Request to Sweep Hump or Dip in Road Unpaved Road Needs Blading (Smoothing) Snow or Ice on Road Street Flooded Manhole Cover Loose or Rattling Storm Drain Loose or Rattling Valve Cover Loose or Rattling Other (Describe Below in Comments Section)

Address of Street Failure

(If Possible)

Cross Streets (Required)

One Street Name per Line

Specifics about Location of Street Failure

All of the information in this section is based on the cross streets listed above, so please make sure that the cross streets are accurate!

Where is the Failure?

Choose One

In Crossing
On Street

Where in Crossing?

N/A NW Corner NE Corner SW Corner SE Corner Center

On which street?

(Must be one of the cross streets listed above)

Please provide a direction of travel towards the street failure.

(This is necessary to answer the questions below)

N/A Eastbound Westbound Northbound Southbound

Is the street failure before or after the cross street?

N/A Before : 0-15 feet Before : 15-30 feet Before : 30-60 feet Before : 60+ feet ------------------- After : 0-15 feet After : 15-30 feet After : 30-60 feet After : 60+ feet

In Which Lane is the Street Failure?

N/A Left Center Right Left Turn Right Turn

Please List any Nearby Landmarks

Comments (Required)

Your Name

Your Telephone Number

Your E-Mail Address (Required)