E-Gov Services Village of Antioch

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:

* Location of pothole (be as specific as possible).

* 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

Attach a Picture or File (max size: 30MB):

Add Another FIle

CAPTCHA

Check here to have email confirmation of this submission.

* Information is required.

Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience. Responses may be delayed dependent on staffing. If this is an urgent matter, please call Village offices at 847-395-1000.

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