E-Gov Services Village of Long Grove

Roadside Ditch/Drainage Issue Report

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Purpose. This form is used to communicate with village personnel to request services and request information.

* 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.

* Is the road public or private? --- Please, remember that the Village's role and responsibility when it comes to Private Roads is limited. You may also want to consult your HOA on these matters.

Public

Private

* Location of problem.

* Description of problem

* Please check the issue below. If you issue is not listed please check other and describe the problem in the next box.

Erosion

Storm Drained Blocked

other

Please describe the issue

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

Add Another FIle

Click the map where the issue is located. Drag the map point if it needs to be moved.

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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.

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