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2. 
4. NEW, MODIFY OR REMOVE STREETLIGHT REQUEST
6. Requested By
7. First Name
8. Last Name
10. Date Requested
    Date Requested

    Date Requested
11. Address
13. Reply Email
14. Phone
16. Type of Request
18. ADD a streetlight
20. Street Name
21. Map of Exact Location of Request
23. MODIFY a streetlight
25. Street Name
26. Pole Number
28. REMOVE a streetlight outside the applicant's residence located at
30. Street Name
31. Pole Number
33. Reason for request

    An application to remove a streetlight must be accompanied by a map identifying all of the residents within 500 feet along any road in any direction of this streetlight, and a document signed by a representative of each of those residences stating that they are in agreement regarding removal of this streetlight. 

34. Supporting Information
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field