Public Works Service Request

Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I need help with:
Other issue not on list:
Issue with:
What needs repair:
Please describe the maintenance issue:
Upload a photo (Optional)

Cancelof
If your curbside or special collection was missed, please let us know by submitting this request.
You did not pick up my:
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Have you placed your can out for repair?
Any additional Comments:
Any additional Comments:
Closest Address to the Issue
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
2 digit month, 2 digit day, 4 digit yearDate
Pole Number Information
Write Number or Upload a Picture
Cancelof
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.
Do you have any additional information about the issue?
How may pictures of the issue are you uploading?
Upload Images

Cancelof
Significant pollution incidents presenting an imminent threat to human health or the environment should be reported to local 911 and not through the online form.
Type of Discharge
Date of Occurrence

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload Photos of Incident

Cancelof
Responsible Party
Brief Description of Issue and Specifics
Location of Issue Being Reported

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Should be Empty: