Service Request Form

Service Request Form

Report the issue type, add the location, and include any extra details or photos to help us respond quickly.
Date

MonthDayYear
Date
I am reporting

Other
Type of Vegetation Management

Other
Type of Drainage Issue
For street light outages, Dominion Energy is responsible for making the repairs. Public Works will submit the outage request to Dominion on the resident's behalf and monitor the request through to completion.
Issue with Street Light:
Subdivision Name
Street Address (House Closest to Pole)

Street Address

Street Address Line 2

State / Province

Postal / Zip Code
Intersecting Street
Observed on

MonthDayYear
Date
Pole Number Information
Write Number or Upload a Picture
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Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Please help us respond efficiently by providing a location for the reported issue.
Closest Address to the Issue
Do you have any additional information about the issue?
How may pictures of the issue are you uploading?
Upload Images

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Should be Empty: