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2. Please use this form to request assistance from the city. You may also visit the Customer Service Center in the Municipal Building at 700 N Jefferson, Monday through Friday from 8 am to 4:30 pm, or call us at 785-238-3103.
4. Name*
6. Email*
7. Phone
9. Address
11. City
12. State
13. Zip Code
15. Area of Concern
    Select One:
17. Blights
    -- Select One --Dilapidated StructureGraffitiJunk in YardTall Grass / Weeds
18. Sanitation
    -- Select One --Appliance Pick-upMissed TrashPoly Cart IssueSpecial Trash PickupTrash Pickup
19. Sewer
    -- Select One --Grease Trap InspectionLift Station IssueSewer BackupsSewer Line Issue
20. Streets
    -- Select One --Alley IssueDowned TreesFaded CrosswalksPot HolesRoad KillRough and Bumpy PavementStorm DrainStreet CleaningStreet FailureStreet FloodingStreet LightsStreet Lines FadedStreet SignsTraffic LightsUneven StreetsUnmarked Dips
22. Vehicles
    -- Select One --Abandoned VehicleBoats or Trailers Parked in StreetIllegal ParkingParking on Grass
23. Water
    -- Select One --Broken Water Meter LidsDirty WaterLeaking Water MeterLeaky HydrantLow Water Pressure
24. Parks
    -- Select One --GraffitiPark EquipmentPark Safety IssueTrees / ShrubsOther
25. Other
    -- Select One --Loud Noise / MusicSanitation / TrashSewer Back-upStray AnimalsTrees / Shrubbery Issues
27. Location of Problem*
29. Upload Pictures
    Please use this to submit photos of your issue.
31. Comments
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field