Request For Service or Complaint Form
City of Port Washington Public Works Department
Service Request or Complaint Type
*
Asphalt Needed For Driveway
Brush Pick-Up
Grass/Weeds - Please Check
Plowing Complaint
Plowing Needed
Pothole - Please Check
Salting Complaint
Salting Needed
Tree - Please Check
Other - Please Specify Below
How May We Contact You
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Phone
Email
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Secondary Phone Number
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Area Code
Phone Number
Email Address
Upload Photo/File (optional)
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