E-Gov Services City of Carlsbad

WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 575-885-6262 or 911.

Pothole/ Street Condition

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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 - Invalid Address The address you entered does not match any in the system. You can select a valid address from the list, or if you are certain the address you entered is correct click the "Use the address I entered" button, to continue. The address you entered
Unit:
	Provide any additional information on problem location in the box below.

* Location of condition problem (be as specific as possible).

If You are reporting a pothole, what is the size?

Small (less than 12 inches across)

Medium (12-24 inches)

Large (over 24 inches)

If you are reporting a condition other than a pothole, describe the condition issue. Please be as specific as possible.

Special Circumstances

Is creating traffic hazard

On major street

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

Add Another FIle

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Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

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