E-Gov Services Town of Somers

Pothole

Click here to Login | Click here to Register

Purpose. Use this form to report a pothole.

* Information is required.

Contact Information

First Name:
Last Name:
Business Name:
Email:
Daytime Phone:	() –
Fax:	() –
Address:
City:
State:
ZIP:

Issue/Problem Location:

* Address:	- Or Other Not Listed -
Unit:

	Provide any additional information on problem location in the box below.

Please provide any other information you would consider helpful in resolving this situation.

* Size of pothole

Small (less than 12 inches across)

Medium (12-24 inches)

Large (over 24 inches)

Special Circumstances

Is creating traffic hazard

On major street

Check here to have email confirmation of this request sent.

* Information is required.

Notes:

If you send us a message including your e-mail address, you'll receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Information we receive may be considered public information which is subject to disclosure under current state law. Learn more about our Privacy Policy.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.