To initiate the request for the addition of a mid-block street light in a residential area, please complete and submit this form. It is pre-addressed to arrive at the correct destination when you click on the Submit button below. Street Transportation Department staff will call you to explain the specific process for your particular request. NAME OF STREET WHERE POLE IS TO BE LOCATED*: (Example: 12th St.) CLOSEST ABUTTING STREETS ON EITHER SIDE OF POLE: Between*: (Example: Bethany Home Road) And*: (Example: Rose Lane) YOUR NAME*: STREET ADDRESS*: CITY*: STATE*: ZIP*: DAYTIME PHONE*: (Use 10-digit phone number) E-MAIL ADDRESS: ADDITIONAL INFORMATION REGARDING THIS REQUEST: *required field Before you submit this e-mail form, we would like you to be aware of the City's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.
Street Transportation Department staff will call you to explain the specific process for your particular request.
NAME OF STREET WHERE POLE IS TO BE LOCATED*: (Example: 12th St.)
CLOSEST ABUTTING STREETS ON EITHER SIDE OF POLE: Between*: (Example: Bethany Home Road) And*: (Example: Rose Lane)
YOUR NAME*:
STREET ADDRESS*:
CITY*:
STATE*:
ZIP*:
DAYTIME PHONE*: (Use 10-digit phone number)
E-MAIL ADDRESS:
ADDITIONAL INFORMATION REGARDING THIS REQUEST:
*required field
Before you submit this e-mail form, we would like you to be aware of the City's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.
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